As a practicing chiropractor here in Coeur d'Alene, I have seen more than a few concussions with high school athletes. The parents always say, "When can they go back to playing?" So here are some simple guidelines you can follow.

* What is a concussion?

A concussion is an injury to the brain that may be caused by a blow, bump, or jolt to the head. Concussions may also happen after a fall or hit that jars the brain. A blow elsewhere on the body can cause a concussion, even if an athlete does not hit his/her head directly. Concussions can range from mild to severe, and athletes can get a concussion even if they are wearing a helmet.

* Signs and symptoms of a concussion

Athletes do not have to be "knocked out" to have a concussion. In fact, less than 1 out of 10 concussions results in loss of consciousness. Concussion symptoms can develop right away, or up to 48 hours after the injury. Ignoring any signs or symptoms of a concussion puts your child's health at risk.

* Signs reported by observers:

• Appears dazed or stunned

• Is confused about assignment or position

• Forgets plays

• Is unsure of game, score or opponent

• Moves clumsily

• Answers questions slowly

• Loses consciousness (even briefly)

• Shows behavior or personality changes (irritability, sadness, nervousness, feeling more emotional)

• Can't recall events before or after hit or fall

* Symptoms reported by athlete:

• Any headache or "pressure" in head (How badly it hurts doesn't matter)

• Nausea or vomiting

• Balance problems or dizziness

• Double or blurry vision

• Sensitivity to light and/or noise

• Feeling sluggish, hazy, foggy or groggy

• Concentration or memory problems

• Confusion

• Does not "feel right"

• Trouble falling asleep

• Sleeping more or less than usual

* Your child must be honest

Encourage your athlete to be honest with you, his/her coach and your health care provider about his/her symptoms. Many young athletes get caught up in the moment and/or feel pressured to return to sports before they are ready. It is better to miss one game than the entire season - or risk permanent damage.

• No athlete should return to activity on the same day he/she gets a concussion.

• Athletes should NEVER return to practices/games if they still have ANY symptoms.

• Parents and coaches should never pressure an athlete to return to play.

* The dangers of returning too soon

Returning to play too early may cause Second Impact Syndrome (SIS) or Post-Concussion Syndrome (PCS). SIS occurs when a second blow to the head happens before an athlete has completely recovered from a concussion. This second impact causes the brain to swell, possibly resulting in brain damage, paralysis, and even death. PCS can occur after a second impact. PCS can result in permanent, long-term concussion symptoms. The risk of SIS and PCS is the reason that no athlete should be allowed to participate in any physical activity before they are cleared by a qualified health-care professional.

* Recovery

A concussion can affect school, work, and sports. Along with coaches and teachers, the school nurse, athletic trainer, employer, and other school administrators should be aware of the athlete's injury and their roles in helping the child recover. During the recovery time after a concussion, physical and mental rest are required.

A concussion upsets the way the brain normally works, and causes it to work longer and harder to complete even simple tasks. Activities that require concentration and focus may make symptoms worse and cause the brain to heal slower. Studies show that children's brains take several weeks to heal following a concussion.

Dr. Wayne Fichter is the lead doctor at Disk and Spine Northwest, a comprehensive outpatient rehabilitation center specializing in the treatment of serious, chronic back pain, acute injuries and postural/scoliosis problems. Contact him at diskandspinenorthwest.com or (208) 215-3261.