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?
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:
_______________________At time of concussion....Today
1. Bell Rung
6. Excessive Sleep
8. Feel “in a fog”
9. Feel “slowed down”
12. Loss of Consciousness
13. Memory Problems
17. Poor Balance
18. Poor Concentration
19. Ringing in the ears
21. Sensitivity to Light
22. Sensitivity to Noise
23. Trouble Falling Asleep
24. Vacant stare/glassy eyed