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Interviewer: You're wondering if you should let you kids play contact sports that could lead to concussion injury. What are some of the things that you should discuss and think about? We'll find out from concussion expert Dr. Colby Hansen next on The Scope.

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Interviewer: Dr. Colby Hansen is a concussion expert at University of Utah Orthopedic Center's concussion clinic. Ultimately, I think the question that every parent would want to know given the stories and a lot of talk about concussions in the media, is it still safe or is it safe for my kids to play sports? I suppose you get that question a lot know a days.

Dr. Hansen: I do. I would say, yes, it's totally appropriate for kids to play sports.

Interviewer: Even football.

Dr. Hansen: Yes.

Interviewer: Which seems to be . . . is that the highest risk of a concussion, that sport?

Dr. Hansen: Football is right up there. There are others that are near it - hockey, things like rugby, soccer not too far behind, wrestling.

Interviewer: So it's still safe in, your opinion, for kids to play sports.

Dr. Hansen: I think you have to ask yourself the question, "What is the value of my kid in playing sports?" which I think are numerous.

Interviewer: Maybe basketball would be a better option than football? Where should a parent stand on that?

Dr. Hansen: If we talk about football specifically. Yes, football has some risk to it. Might there be an appropriate age where it's best to start to engaging in football and maybe a younger age where they shouldn't? I don't know. I am not really going to comment on that or try to pretend to be the expert or sounding board for that.

Interviewer: Is there research going on right now or research that would point to an answer to that question?

Dr. Hansen: Well, I know that some groups are interested in taking measures to reduce the number of impacts that people sustain playing a contact sport, like football. There are visible things that people who watch football might see as being measures in that regard - reducing the number of kick-off plays, increasing the number of touch-backs that occur, rules to prevent helmet-to-helmet or targeting types of collisions.

In the background there are lots of efforts to try to educate athletes, and coaches in proper tackling techniques. There are even rules now that are coming down limiting the number of contact practices in full pads, in full gear, to reduce the amount of contact that's sustained over the course of the season.

Those are, I think, appropriate measures. I don't know that we know exactly what's an acceptable amount of collisions to sustain. I think a lot of it eventually comes back to educating coaches, educating parents, educating athletes.

Where I see, perhaps, the biggest problem is when the initial injury may occur and it's not recognized. Instead of taking the kid out of play and observing them or even just making them sit out the rest of that practice or game, there is a tendency to, I think, brush it off. Whether it's on the part of the coach or the athlete, I think, sometimes both at fault, and just rush them out there, and say, "You're okay, let's go at it." That's where you're at risk.

Interviewer: Is that one of the most dangerous things that can happen? You sustain a concussion type head injury, and you go get one immediately right after that?

Dr. Hansen: Exactly.

Interviewer: That's where problems really start arising.

Dr. Hansen: Yeah. There's a saying that goes around in the concussion world, "When in doubt, sit him out." I think that is totally appropriate, there's nothing wrong with that. Is it, perhaps, on the conservative side? Sure. But I think it may well prevent some of these other complications that arise when it's not recognized and then what you have is a situation where kids are, perhaps, sustaining multiple, subsequent collisions over the course of a game or perhaps a few practices. It starts to add up.

Interviewer: Let's go down that path for a second. Are there lasting effects that can occur from those multiple sustained injuries if enough recovery time in between doesn't happen?

Dr. Hansen: I would say yes. From animal model data, and what we see from following players over time in some studies that have done that over the course of a season, if not given adequate recovery time, I think that certainly is a huge risk factor, maybe one of the biggest, for prolonged problems and symptoms that, unfortunately, in a few instances, may not go away.

Interviewer: What's your advice to a parent that has a kid in a sport that can lead to concussion or multiple concussions? Do you have children?

Dr. Hansen: I do.

Interviewer: And as a parent and an expert on concussions what's your strategy on this? What's your thought?

Dr. Hansen: My kids aren't, frankly, interested too much in those types of sports.

Interviewer: Does that make you a little happy on some level?

Dr. Hansen: So that takes some of the pressure off.

Interviewer: Nobody got a concussion in band.

Dr. Hansen: Exactly. I would say it's appropriate to allow kids to play in sanctioned sports, if there are sanctioned leagues and things out there. I think it's appropriate to make sure that the kids have the correct and correct fitting safety equipment. I think a lot of it comes back to the education piece. If an accident occurs, which there is often times not much you can do to prevent an accident, that you manage that appropriately.

Now there gets to be a point where if somebody sustains a number of injuries where you many have to re-think that. Unfortunately, we don't have the magic answer to what's acceptable. How many is too many? We frankly don't know the answer to that question. It should raise some concern if you're starting to have repeat injuries and cause you to re-think that whole issue.

That too, I think comes back to where it may be helpful to talk to a specialist in this area to help you think through those types of questions. Even understanding that even we may not have a definitive answer based on absolute proven scientific research.

Interviewer: And that's something you do at the concussion clinic here at University of Utah Health Care. You'll have consultations, you do some base-line testing, I saw. You consult with sports teams, that sort of thing to help. So, information, knowledge really the most powerful thing right now.

Dr. Hansen: Yeah, I think that's a huge, huge part to what we do. When is it okay to get back to playing? What's appropriate to kind of think about or do we need to maybe think about maybe switching sports altogether? Or any number of things.

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Interviewer: The Will Smith movie "Concussion" focuses on a condition called Chronic Traumatic Encephalopathy. Dr. Colby Hansen is from the University of Utah Orthopedic Center Concussion Clinic. Dr. Hansen, tell me about this condition.

Dr. Hansen: Well, I think in general there's still so much for us as a scientific community and as a medical community to understand about this entity that is highlighted in the movie, chronic traumatic encephalopathy. I mean, it seems pretty clear that trauma is a common denominator, but we don't know to what degree genetics may play into this, to what degree other types of issues may play into it, either mental health disorders or whatnot. We don't know at what amount of exposure to trauma people are put at risk. Just frankly, there's a lot to tease out before we start being over-reactionary and pulling the plug on sports and things of that nature.

Interviewer: The condition that they're talking about in the movie, what exactly is that?

Dr. Hansen: Chronic traumatic encephalopathy is really a diagnosis that can only be made postmortem or after death by autopsy. What some of these researchers are seeing are abnormal collections of clumps of protein called tau that has also been linked to other degenerative diseases like Alzheimer's dementia. They've seen these under the microscope of some of these former athletes, and there's really no denying that they've seen this. So now they're in a phase of trying to characterize are there maybe certain areas of the brain where you get this kind of collection more than others, to what degree does this correlate with known behaviors or symptoms that the patient was experiencing while they were alive, and then ultimately trying to make the link back to the sport or the activity that they were engaged in. People would generally feel or believe that not every football player who progressed through to the NFL has this disorder, so who does and who doesn't and what are the differentiating factors between who does and who doesn't.

Interviewer: Do people that don't play football develop this disease?

Dr. Hansen: At least in terms of the case series, the group at Boston led by Dr. Ann McKee, who's a neuro pathologist there, has studied the most brains and they are not exclusively football players. This disorder was originally described many, many years ago, many decades ago, in boxers, and was termed Dementia Pugilistica which literally means "boxer's dementia." We would assume that the common denominator is trauma, but we don't know much beyond that. How much trauma, at what age the trauma occurred, there's even a lot of debate now not in just concussions, but just the repeated impacts that don't necessarily produce a clear, observable concussion.

At the end of the day there is so much for us to learn, to understand, about not only the impacts of a single concussion and how is the best way to manage it, how is the best way to assess it, but of course the long-term ramifications of concussions and repeated concussions in the health of our athletes and anybody who's active.

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Interviewer: Going to find out what to expect when you go to the University of Utah orthopedic center concussion clinic. That's next on The Scope.

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Interviewer: Let's say something happened to somebody that led to a concussion, whether it's playing football or skiing and took a nasty fall, or maybe even an accident. I've gone to my primary care physician or it's pretty clear that I do have a concussion, and I make an appointment with the concussion clinic. What should I expect after walking in the door?

Dr. Hansen: You'll be evaluated by a specialist in traumatic brain injury. As far as what the evaluation entails it will include a comprehensive look at what types of symptoms you are experiencing, what were the circumstances of the injury, what other medical problems do you have that could contribute in some way to the symptoms you're experiencing. For example, if somebody has a chronic headache disorder already and then they have a head injury, that certainly can affect how they experience their headaches, for example.

We'll want to find out if they've had head injuries before and if so, how did they occur, what was the recovery pattern. Beyond that history gathering, we'll perform a physical examination that looks at a good balance assessment. We know that that is often affected after a head injury. A general neurologic examination which is typically normal. Then, an assessment of how your eyes and vestibular system are working together and maybe provoking or aggravating symptoms.

Those are the main components of our physical exam. Depending on the circumstances there may be other supplementary tests that we do. The ultimate goal is to document what might be aggravating symptoms, what maybe is not back to normal, because in the case of athletes or people who are wishing to return to sports, or otherwise potentially risky activities, it's really important to make sure that you're "100%" before going back out into harms way.

Interviewer: So a lot of basic tests, a lot of questions, some balance tests, but what about some sort of a brain scan?

Dr. Hansen: Brain scans typically aren't very revealing. If you have a severe injury and show acute signs or symptoms that there might be a more serious problem in the brain, people with those sorts of issues usually end up in the emergency room and those appropriate scans are done at that time.

Interviewer: So imaging is not something that you normally would do there at the concussion clinic.

Dr. Hansen: Not typically. Certainly if the story doesn't add up or we're concerned about something else, but I guess I would say that imaging tests don't diagnose a concussion.

Interviewer: What kind of questions should the patient be asking when they're in the clinic? Is there anything in particular they should be actively doing?

Dr. Hansen: If I could put myself in a patient's shoes or in a parent's shoes, and certainly I'm a parent, how do I know when it's safe to go back and play such and such a sport? Or if I'm having symptoms that aren't going away, what can we do about it? It's a tricky process to navigate.

One of the big things that we try to tackle in our clinic is providing adequate education into how to manage this, and adequate support they can then take back to their work environment, their school environment, their coach, or whatever so that they can educate them on what's the right things to do or not to do to help facilitate getting better.

Interviewer: What are some of the treatment options that you might give a patient after they've come in and you've done the diagnosis? You mentioned medications could be one.

Dr. Hansen: Most of medical management of concussion is geared towards symptom management. There's not a pill that cures a concussion. Medications have a role. There are times when the best medicine is just education and helping them understand the right balance between rest and activity, how to scale things back, and how to tailor their daily activities to facilitate recovery. Sometimes we'll get rehabilitative therapies involved, physical therapy if somebody is struggling with a lot of dizziness or vertigo, or even a lot of neck pain sometimes coincides with their concussion.

Interviewer: If I got a concussion it sounds like rest . . . is rest a big part of it? I guess what I'm saying is instead of coming in, why don't I just rest for a few days?

Dr. Hansen: Sometimes that is the trick. We know that about 50% of concussions will spontaneously get better on their own without doing anything particularly special. The important thing in those situations is just making sure that you're not getting back into harms way too soon.

There are however cases research would suggest probably in the ballpark of 20% of patients may still be having problems even a month out from their injury. Continuing to just rest and do nothing there gets to be a point of diminishing returns I guess I would say where that's not helpful and you need to figure out how to balance the right amount of rest with the right amount of activity.

Interviewer: Certainly somebody in that particular category is somebody that you would want to see, if a month has gone by and they've still got symptoms.

Dr. Hansen: Absolutely, yeah. Some guidelines would even argue that anything beyond two weeks may merit a specialist evaluation.

Interviewer: It sounds like if somebody has had no history of having concussions, and has received one, resting for a few days would be fine. They probably don't need to come into the clinic unless those symptoms persist.

Dr. Hansen: Yeah, they probably don't need to come into necessarily our clinic, but it is super important to check in with a healthcare provider.

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