Bill Moore Smith

The symposium was supposed to focus on soccer concussions, which actually may surpass football concussions in frequency in this country when you include both males and females.

In fact, young women may be as much as three times more likely to suffer a concussion than their male counterparts, according to Dr. Bill Moore Smith of the UT Erlanger Institute for Sports and Health.

But asked last Saturday to recall the youngest severe concussion he'd seen, Dr. Smith reverted to football, to a 9-year-old boy.

"It took more than two months to resolve it," he said Saturday from Erlanger's facility near the Volkswagen plant. "He got hit on the side of the head, developed a headache, but played the rest of the game."

Then the boy went home to live with his headache, and dizziness, and upset stomach. By the time his parents took him to see Dr. Smith a couple of days later, he not only couldn't pass the one-legged balance test, he couldn't pass a memory test.

"That's unusual," the doctor said. "But it can happen. The thing to know about concussions is that they're all different. When you're treating a concussion, it's all individualized medicine."

It seems you can't escape news about concussions these days, and that's a good thing. Whether it's the NFL, college football or the World Cup, the medical issues associated with hits to the head have become almost as big a topic as the games themselves, at least partly because those who suffered too many of them 50 years ago now have s0 much trouble remembering those games, or much of anything else.

"I've been a trainer for 22 years, and when it comes to concussions the first 15 of those years were spent in the dark ages," said Steve Carpenter, an athletic trainer at Ringgold High School and a parent in the Redoubt Soccer Association, which sponsored Saturday's symposium.

"All we had until recently were conversations. Now we have testing with objective data."

Indeed, while Dr. Smith admits that the only certain cure for a concussion is rest, certain simple tests -- including the one-legged balancing test -- give doctors, trainers and parents far more information than an "Are you OK?" question.

Even then, it too often has come down to how much the player wanted to return to play or how much the coach felt the player was needed to win the game.

"And I still fight with coaches on occasion," said Dr. Smith, who works with several local high schools as well as the University of Tennessee at Chattanooga.

But thanks to legislation in all 50 states, that's rapidly disappearing. Very specific guidelines from the Tennessee Secondary School Athletic Association and Georgia High School Association, for instance, state that no athlete diagnosed with a concussion can return to play until he is cleared by medical personnel. And no athlete can return on the same day the concussion occurs.

"It's still difficult," Dr. Smith said. "The pressure is there to compete. In the heat of competition no one's thinking about what he or she might be like 60 years from now. In the middle of a game you'll even hear parents say, 'He's tough. He's OK.'"

Added Carpenter: "Sometimes the parent is the first one to argue with you."

Yet left unchecked, that's often where the most damage is done.

"Where kids get into trouble is not saying anything, then going back out there and suffering a second concussion," Dr. Smith said. "It's called Second Impact Syndrome, and that's real trouble."

Statistics tell an uncomfortable story. The Centers for Disease Control estimate that 1.6 million to 3.8 million concussions occur a year. Read that again. There's a gap of 2.2 million possible concussions.

"And we think there could be 50 percent more that occur that are never reported," Dr. Smith said.

Moreover, the CDC estimates that males have a 75 percent chance of suffering a concussion in football while female soccer players have a 50 percent chance. Some studies suggest females are twice as likely to suffer concussions as males. Athletes also are 78 percent more likely to suffer a concussion in games compared to practice.

And why are girls more at risk for soccer injuries than guys?

Said Carpenter: "Some think it's because we train our female athletes like girls. Guys tend to do more work strengthening their necks and upper backs. The stronger you are there, the more head control you have."

Added Smith: "Concussions don't always occur because of contact only. A concussion can come from the neck being twisted."

Yet whatever causes it, and whichever gender is more at risk, Carpenter said there is no gray area concerning continuing to play.

"With some injuries, there's a risk-reward argument to be made," he said. "If a kid's got a twisted ankle in the state title game and he wants to play, maybe you let him. But when you're talking a head injury, there is no reward."

There's also at least one treatment rule to follow: tylenol, but no aspirin. Nothing that would thin the blood.

"And any symptons -- headaches, nausea, dizziness, balancing problems, fatigue -- that persist for three days or more need to be addressed by a physician," Smith said.

The symposium definitely made an impact on local doctor Eugene Long, whose daughters Lydia and Cora both play soccer.

"I've seen this happen so many times," Dr. Long said. "But I didn't realize that headaches were a prime symptom to look for. Concussions are something we all need to learn more about."

For Carpenter, it all comes down to a simple six-word slogan every coach and parent should memorize.

"When in doubt," he said, "pull them out."

If they don't thank you now, they'll at least know whom to thank years later.

Contact Mark Wiedmer at mwiedmer@timesfreepress.com.