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Dr. Robert Cantu, renowned neurosurgeon, sheds light on Florida Gators quarterback Tim Tebow's concussion

GAINESVILLE -- Don't expect University of Florida quarterback Tim Tebow to practice this week but he could be ready for the Gators' away game on Oct.10 against No.4 Louisiana State, according to Dr. Robert Cantu, a renowned neurosurgeon who is considered a leading expert on return-to-play guidelines for sports concussions.

Because we're just as concerned about Timmy as the rest of the college football world, Gator Clause decided to go directly to the source for an explanation for our many questions regarding sports-related concussions, the many grading scales used in diagnosing concussions and, most importantly: When is it OK for Tebow to return to the playing field?

Bio_cantu

First, an introduction: Dr. Cantu published the first ever return-to-play guidelines for sports concussions in 1986 (known as the Cantu Scale). Slightly revised in 2001 and still the most widely recognized guidelines by athletic trainers, he devised the first grading system for concussions based on symptoms at the time of injury (Grades 1, 2, 3) and provided medical professionals with concussion management guidelines where there existed none before.

Dr. Cantu served as President of the American College of Sports Medicine (ACSM), the oldest and largest sports medicine and exercise-science organization in the world, from 1992 to 1993. At the 2007 ACSM's annual meeting, Dr. Cantu was asked to give the prestigious J.B. Dill Lecture, and presented "The History of Concussions."

Q&A with Dr. Robert Cantu:

OK, so we've established that there is pretty much no one else in this world that knows more about sports-related concussions than Dr. Cantu. With the introductions out of the way, here's a Q&A I had with Dr. Cantu on Monday morning. It should be noted that Dr. Cantu spoke in generalities on Monday as he is not familiar with Tebow's case, medical history or symptoms. Generally speaking, according to Dr. Cantu, Tebow will likely be able to return to the practice field after a week if he is asymptomatic in the next few days.

Q: What are the chances Tebow returns to the field after a week of rest?
A: The bottom line is, as I think you can appreciate, when you talk about concussion and recovery patterns and all that stuff, it's a bell-shaped curve and the majority of people return within a week, probably about 75 to 80 percent. But that's not everybody, and there is no way on Day One to know whether someone is going to clear and be in that 80 percent group or be in that 20 percent group where symptoms may go on and last more than a week or even weeks.

It's possible that Tim could be in the fortunate group and within another four or five days he's asymptomatic and it's also possible Tim could be in that group that he is still going to be symptomatic in four or five days. And if he's in that group it's not safe for him to practice much less even work out. He should be asymptomatic at rest before he's allowed to exert himself and see whether exertion produces symptoms.

Q: What is Tebow doing right now, in the next few days, to recover from his concussion?
A: Right now it's a cognitive rest period for Tim and a physical rest period, waiting for all of his symptoms to clear and his case, I think it was complicated by the fact that he was playing with the flu, and that's going to have to be sorted out -- whether any of his ongoing symptoms are flu-related or concussion related. So, it's going to be to a little more tricky.

Q: Is loss of consciousness an indication of a severe concussion?
A: Brief loss of consciousness -- and by brief I'm talking about seconds -- is really not correlated necessarily to a severe concussion. It's certainly a moderate concussion but it's not necessarily indicating his symptoms are going to last a long period of time or that he's going to be out a long period of time.

If you're unconscious for more than a minute, then that is a severe concussion and tends to be associated with a slow recovery.

Q: Did Tebow's preexisting illness have anything to do with his concussion?
A: It doesn't at all. It just means that you're going to have to be comfortable knowing which symptoms he may have now are flu related versus concussion related. Many of the 25 symptoms of concussion -- for instance headache, light-headedness -- are shared symptoms with many other medical conditions, too. It doesn't have to be related to a concussion if it happened right after head trauma. But if you already had some kind of medical condition going on, for instance if you had some kind of headache or light headedness before because you had the flu, then you're going to have to sort it out -- whether you think it's the flu or whether you think it's the concussion. It adds a little bit of complexity for the assessment to be properly done.

Q: What will UF's doctors be looking for in the next few days?
A: Most importantly you are looking for the symptoms to clear, those that are there. Before they totally clear, you're looking for them to get better. And that's the normal pattern. Those that are there will diminish in their intensity and go away. And that may happen within a day. That may happen within a number of days. It may take weeks. If it takes weeks, then he's going to be out a long time. That's probably unlikely for him because he's not had prior significant head injuries, so that's an optimistic thing for him compared to someone who has had a lot of concussions before.

What the medical team chooses to do will be their individual decision but for sure he shouldn't be practicing until all of his symptoms are cleared.

Q: Florida has a bye week this week and doesn't play its next game until Oct. 10. How might this affect Tebow's recovery and return?
A: That is extremely fortuitous. That's huge. That's great. There should be no other consideration other than letting this guy get over his symptoms.

Q: Tebow spent the night in Kentucky and underwent CT scans. What were doctors looking for?
A: They were looking for inter-cranial bleeding. There not looking, per say, for the effect of a concussion because you don't see it on a CT or on an MRI. You're only looking for other things that may be associated with head trauma like bleeding. And the fact that it was normal is good. It just means he had a concussion. Nothing more.

Q: You helped the sports medicine field understand concussions by creating a grading scale. What would Tebow's grade be, based on your knowledge of sports-related concussions?
A: If you use my grading scale, you would realize that you can't grade it until the symptoms are over. Because the severity is really determined by how long the symptoms last. And we don't know how long his symptoms have lasted. We know it's a Grade II minimum but he may get into a Grade III if his symptoms last over a week.

Q: Is grading a concussion difficult? Is there room for ambiguity or is it clear cut?
A: It's very clear how you grade it. It's not ambiguous or hard to figure out. There are just many people that choose to not grade a concussion because you don't need to use a grade to manage concussion because you need to be asymptomatic before you start to return again no matter what the grade. I personally think it's very useful to grade a concussion not so much for that one but for subsequent ones. If someone has had a severe concussion, then that's more alarming than someone who had a minor one.

Here is Dr. Cantu's daily checklist of symptoms he recommends using for evaluating a player who has had a concussion:

_______________________Symptoms.................Symptoms

_______________________At time of concussion....Today

1.   Bell Rung

2.   Depression

3. Dinged

4. Dizziness

5. Drowsiness

6. Excessive Sleep

7. Fatigue

8. Feel “in a fog”

9. Feel “slowed down”

10. Headache

11. Irritability

12. Loss of Consciousness

13. Memory Problems

14. Nausea

15. Nervousness

16. Numbness/Tingling

17. Poor Balance

18. Poor Concentration

19. Ringing in the ears

20. Sadness

21. Sensitivity to Light

22. Sensitivity to Noise

23. Trouble Falling Asleep

24. Vacant stare/glassy eyed

25. Vomiting

-jo-

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Jo, i got a completely irrelevant question. What is Robert Cantu's nationality. I would greatly appreciate if you would be able to answer my question.If not, then dont worry about it. Thank you for your time.

Great post, jo.

He is not related to Jorge Cantu, if that is what you are asking.

the reason i ask this is because the last name is only specific to mexicans and mexicans only. There are'nt any records that show that the last name is found anywhere else. Jorge Cantu, Sandra Cantu (rest in peace). Anyways, he must be like the coach at Michigan where he might have had past relative with the last name rodriguez

Jo, I sure you are cranking the Gator nation contacts for some inside scoop. In my research I have seen that there are 5 Grades to concussions. Basically decided by what you remember either before (Grade II) or after (Grade III) the concussion. Grade II out one week, Grade III out one month. Obivously, we are not dealing with Grade I, IV or V. But a huge difference between one week and one month..... Any inside information yet?

Emilio,

He's American. Works in Concord, Mass.

Ed,

Inside sources don't have much to say right now. It's wait-and-see time. Also, calls to John Brantley's father have not been returned.

-jo-

Thanks Jo. Down here in South Florida not much news other than the "u" fans hated on Tebow!

Ok, thank you for the response.

Great syntax Ed. By the looks of your statement, I guess we don't hate Tebow anymore!

It's 'cane football 24/7 over here Jo, I love it!

Go 'canes!

Bottom LINE...UF is in trouble...TEBOW will not be 100% the remainder of this season...so much for NC #4....

See you in 2010....

Cane Grad you are an idiot!! But I could tell that from your name! Oklahoma will put up 100 points on your mediocre team..I guess that FSU win doesn't look so good after they got beat by a terrible USF team! See ya in the San Diego County Credit Union Bowl!!

A terrible USF team? A terrible conference maybe, but that team AND QB are for real!

they can do it! I have faith in tebow and urban myers getting back on track. even if they don't, I am still tebow's #1 fan! I 3 u tebow!

1st let me get this out of the way, I am a Miami Hurricane fan all the way back from 1978

I know both our fans like to go back and forth making digs at each others programs, but this isnt why im here

Ive been thru this concussion mess before. I received my 1st concussion while macking a tackle, and while I didnt throw up it did have me out there quite a bit

After a week I passed the tests they gave me and went back out on the field

2 games later in what was a meaningless tackle I started feeling light-headed but still went on and never told anyone. I kept playing and never worried about it. You see your team mates out there doing all they can to be out on that field with visible injuries you feel like you cant let them down. Thats your family out there.

Well a few years later and I suffer seizures because of my concussions and have to see my neurologist at Bayfront Mediacal Center every 3 months for the rest of my life and pop pills everyday.

Yes my memory fades in and out on some days and if a seizure does occur it hurts like hell

I know I rambled here but my point is that this is a very serious matter that shlouldnt be taken lightly at all. The last person that needs to be involved in the decision is T.T.

OK so back to the bashing I guess LOL

the word is fortuitous, not fortiuties

1st let me get this out of the way, I am a Miami Hurricane fan all the way back from 1978

I know both our fans like to go back and forth making digs at each others programs, but this isnt why im here

Ive been thru this concussion mess before. I received my 1st concussion while macking a tackle, and while I didnt throw up it did have me out there quite a bit

After a week I passed the tests they gave me and went back out on the field

2 games later in what was a meaningless tackle I started feeling light-headed but still went on and never told anyone. I kept playing and never worried about it. You see your team mates out there doing all they can to be out on that field with visible injuries you feel like you cant let them down. Thats your family out there.

Well a few years later and I suffer seizures because of my concussions and have to see my neurologist at Bayfront Mediacal Center every 3 months for the rest of my life and pop pills everyday.

Yes my memory fades in and out on some days and if a seizure does occur it hurts like hell

I know I rambled here but my point is that this is a very serious matter that shlouldnt be taken lightly at all. The last person that needs to be involved in the decision is T.T.

OK so back to the bashing I guess LOL


COMPLETELY LAME CANE FAN IN DRAG....COMPLETELY

"See ya in the San Diego County Credit Union Bowl!!"

That's just good comedy

Thanks, Apples. Corrected.

-jo-

COMPLETELY LAME CANE FAN IN DRAG....COMPLETELY

Posted by: You just earned an Emmy LOSER | September 28, 2009 at 04:42 PM

I just came here to say I hope everything turns out ok for TT and thats it

I didnt come here to get into any kind of spitting match with a Gator fan

I didnt type one negative comment toward the Gators

Everybody off the Canes bandwagon!

Last week it was National Championship and JH for the Heisman! Now it's "8-4 will be a much improved year!"

Oh well, there will be at least 40,000 fans there for the Oklahoma game....

UPDATE ON TEBOW: He will undergo more tests on Tuesday. Meyer said that Tebow was still symptomatic on Monday (headache). Asked if Tebow will play against LSU, Meyer said, "I think so, but I don't know that."

-jo-

I pray everything works out for Tebow, and I'm sure the Cane fans want the same. The Gators will win the SEC even if Tim doesn't return, b/c this is a very good football team. What the Cane fans fail to remember is defense wins championships, not great passing attacks!
Go Gators

I'm a Canes fan 100%. With that said, I think it's pretty lame to use this forum to talk anything regarding Canes vs Gators.

This is serious situation Tebow is dealing with. I hope it's handled properly by all related parties.

Someone's life and well-being are at stake here and football should be the last thing on anyone's mind.

Well, isn't this something! Suddenly, for some strange reason, all these Cane fans are so concerned with Tim Tebows health and well being! Or could there be another agenda?? Sorry for being so suspicious, but my experience with Cane fans is that they are the most disingenuious fan base in all of sports. They will even turn on their own team in a heartbeat. I witnessed as such at the Swamp last year. For those who are TRULY concerned, the University is not going to unnecessarily jeopardize Tim's health, so go rest easy Cane fans. Maybe you need to worry about the health of YOUR program.

BTW, In reading the various Blogs in the south Florida media, I have recognized a few of these same Cane fans (ie canesrule) that are expressing such concern for Tim were the same ones calling him names and making fun of him prior to his injury. They are just trying to use this as a criticism of Urban Meyer and I'm sure Tim himself if they get the chance. Pathetic. I guess it's just a "Cane Thing".

Great Article

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