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Question: I have a 17-year-old who is into all sports -- from traditional to extreme, he does it all. He plays hockey, snowboards, skateboards, BMX bike rides and wakeboards. He has had several serious spills, with his head taking the brunt of the falls, but I don't know if he has actually had a concussion. He is going snowboarding for March break. What advice can I give him about concussions?

Answer: Your son has lots of company. Many people don't understand the risk of concussion -- or just how debilitating this injury can be. Unfortunately, some find out the hard way.

Here's my first piece of advice for your son, and anyone involved in sports: Don't underestimate concussion. This common form of brain injury temporarily disrupts mental function. If not treated, it can have nasty, long-term consequences. People with untreated concussion may suffer from headaches and fatigue -- sometimes for years. They aren't as sharp as they should be mentally and they can't focus.

We don't yet understand concussion completely, and exact figures are hard to come by. It tends to be underreported because it's an "invisible injury," that is, it can't be seen with the naked eye, or even on an X-ray. One thing we know -- it's common. My colleagues and I recently surveyed a group of university football players and found almost half of them reported symptoms of concussion during the previous year.

Contrary to popular belief, concussion is not always the result of a blow to the head. A hard tackle, a body check, a bad fall on the slopes, are enough to concuss someone. You don't actually have to hit your head -- you just have to be shaken up.

To understand this, imagine shaking a bowl of Jell-O so hard that it wobbles and slaps against the sides of the bowl. Now imagine the Jell-O is the brain, and the bowl -- with rough, ridged edges -- is the skull. Can you imagine how a delicate and complex organ like the brain can be injured, even without a direct blow to the head?

Here's another common myth: "You have to be knocked out to have a concussion." Not true! I've treated many people who have been concussed without losing consciousness. They tell me they just felt stunned or dazed after their injury. Athletes in contact sports talk about a "bell-ringer," to describe the sensation after a heavy hit. That's concussion.

If your son takes a bad fall, advise him to get off the hill right away if he feels woozy or dazed, or sees lights or stars, like in a cartoon. Confusion is another sign to watch for. Right after a concussion, people may not have their wits about them. For instance, in sports like hockey, they might not know the score of the game, or recall which team they're on. Sometimes, symptoms get worse during the next 24 hours. As a rule of thumb, be suspicious.

If your son even suspects he has been concussed, urge him to get to a doctor, the sooner, the better. It's vital to treat concussion early, especially in school-age people. Otherwise, they can lose a semester or even a whole academic year.

Right after a concussion, people are at much higher risk for further injury. They're not able to react or think quickly. Also, the brain is very sensitive after an injury. Reinjuring the brain while concussed can lead to really serious health problems -- far more serious than either of the two injuries alone could cause. In head injuries, one plus one equals four.

Treatment for concussion is simple -- physical and mental rest. Physical rest means don't train, don't run, don't bike, and don't shovel snow -- just rest for a few days, until symptoms settle down. Mental rest means don't go to classes and don't do homework. This can be really tough for young people who have exams or projects coming up. Dedicated students sometimes tell me "I can't rest now." My response is, "Either take a week off now or be prepared to take a couple of months later on."

Most people quickly realize they're not up to mental effort after a concussion. If they try to study or work, they accomplish virtually nothing. Once symptoms have subsided, they can gradually resume active life. In cases of so-called simple concussion, the most common and least serious form of the injury, the person should feel well in a day or two, do a little more each day, and be back to normal in a week or so. The key is to take things step by step. Otherwise, recovery will be a long, slow process.

With early diagnosis and proper care, symptoms resolve quickly in most cases.

Tell your son to enjoy himself but to keep in mind the risks associated with concussion because, if left untreated, it can make life miserable for months or even years. Professional athletes take concussion very seriously. So should the rest of us.

Dr. Karen Johnston is a neurosurgeon and director of the Concussion Clinic at the Toronto Rehabilitation Institute. Her specialty is brain injury, and her main area of research is concussion in athletes. She has served as a medical consultant to numerous professional sports teams.

Ask The Doctor appears every other Tuesday. E-mail questions to

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