The questions came as quickly as the head-jarring blow that knocked University of Florida quarterback Tim Tebow out of the game.
How bad was he hurt? And when can — or should — he return to action?
Those are the questions asked most often whenever an athlete suffers a concussion. But there are often no clear answers when it comes to brain injuries, say experts in the field.
"Rating a concussion is like looking into the sky on a partially cloudy day and agreeing on the exact color of the clouds and percentage of clouds in the sky," said Jeff Konin, who heads the Sports Medicine and Athletic Related Trauma Institute at the University of South Florida.
In other words, it's extremely difficult.
In Tebow's case, it has taken numerous tests and daily monitoring of his symptoms since his Sept. 26 injury before he was finally cleared to return to practice this week. And his status for Saturday's game against LSU, ranked fourth in the nation, remains questionable.
There's good reason for a cautious approach. Doctors now know that athletes who suffer a second concussion before fully recovering from their first one have a much greater risk of suffering long-term or permanent brain damage.
There's even a term for it: second impact syndrome.
But even as high-profile incidents such as the hit on Tebow have helped raise awareness and increase our knowledge about concussions, there are still many unknowns.
For one, initial diagnosis and treatment of concussions remains largely a subjective exercise that often involves a coach or trainer asking the affected player a series of questions, and it can be influenced by factors such as the athlete's desire to return to action.
"If you get hit in the knee or arm, I can see it, touch it, move it, and get a better assessment," Konin said. "I can't do that to the brain."
What is a concussion?
A concussion is an injury to tissues of the body as a result of a violent blow, shaking or spinning. Concussions are most commonly associated with the brain.
What are the symptoms?
There are many, but they include confusion, amnesia, headache, dizziness, ringing in the ears, nausea or vomiting, slurred speech, mood or cognitive disturbances, sensitivity to light and noise and sleep disturbances. Some symptoms come immediately; others may not appear until hours or days later.
What are the types of concussion?
Concussions are graded or classified by severity. The American Academy of Neurology divides them into three grades:
• Grade 1 concussions involve transient confusion, no loss of consciousness and symptoms that are resolved in less than 15 minutes.
• Grade 2 concussions involve transient confusion, no loss of consciousness and symptoms that last more than 15 minutes.
• Grade 3 concussions involve any loss of consciousness, either brief or prolonged.
Konin, however, cautioned that it's nearly impossible to determine the severity of a concussion until after it has run its course.
Since the grading systems are based on the type of symptoms one has and how long they last, "I can't tell you on Day 1 how long they're lasting, and I can't predict how long they will last," he said.
Konin and other experts say all concussions should be taken seriously.
How are they treated?
Rest is the primary way to treat concussions.
"The brain is a wonderful organ that can repair itself if you give it rest," said Dr. Anthony Alessi, a neurologist who represents the American Academy of Neurology.
How much rest is needed?
Guidance varies. The American Academy of Neurology recommends rest periods of between one and two weeks depending on the type and number of Grade 1 and 2 concussions, and one month or longer for an athlete who sustains multiple Grade 3 concussions.
Konin said there are doctors and others who say a minimum of seven days' rest is needed, but others say that you should be free of symptoms for three days before returning to action.
"It's not a cookbook approach," Konin said. "Everyone is treated on an individual basis."
Are we seeing more concussions?
Both Konin and Alessi think so. Konin, however, said an increase in concussions could be attributed to the fact that trainers and doctors are better able to recognize them.
Alessi attributes an increase in concussions to the fact that football players at the pro, college and even high school levels are simply bigger and faster than players of previous generations.
"You have linemen running as fast as halfbacks and fullbacks," Alessi said. "When a quarterback gets hit by one, it's like getting hit by a car."
Richard Martin can be reached at firstname.lastname@example.org or (727) 893-8330