UPDATE: With football season upon us and so many young people participating in this game, it might be a good idea to discuss injuries to the head so often associated with football.

Although the modern plastic football helmet has all but eliminated skull fracture, it cannot and does not prevent concussion because the brain is suspended in fluid, and when the head is hit, can splash around inside the skull. An article relating to the problem of concussion from playing football appeared in the September issue of the "Sports Medicine Digest" (Volume 9, Number 9).According to this article, when a well-padded head is hit (or hits something), that part of the skull actually "strikes" the brain, which then rebounds off the opposite side of the skull. This results in damage to either one or both sides of the brain. If the damage is severe, it can lead to a contusion and bleeding within the skull, and may cause death.

More commonly, the injury is a concussion, which results in a condition that causes athletes to say they have been "dinged." I remember a teammate who got dinged in a high school football game. He could still walk around, but couldn't remember where he was nor what was going on. Even after the game, he kept asking when we were going to play.

In addition to temporary memory loss, athletes who experience a mild concussion may have ringing in the ears, dizziness and headache. There is no loss of consciousness with this concussion, and the recovery is quite rapid. With moderate concussion, the athlete often experiences unsteadiness, blurred or double vision and nausea, but usually recovers in a few minutes. With severe concussion, there is usually a prolonged loss of consciousness, and the recovery is slower.

Any worsening of symptoms following a concussion can be classified as a medical emergency. A decreasing level of consciousness is the most dangerous sign.

What should parents or coaches do if a player is "dinged" during a game? Any hard hit on the head should be reason enough to remove an athlete from a game until a physician can be certain that any symptoms have cleared up. If mild, a physician can clear them for continued play if they are well oriented and can move with their usual dexterity and speed. Those with moderate or severe concussions should not be permitted to continue practice or competition until they are cleared by a neurosurgeon. In addition, players who experience concussion should have some restrictions regarding future play because of the potential dangers associated with this type of injury.

According to one specialist, an athlete who experiences two concussions in one year should be restricted from playing for the rest of the year. Any athlete who experiences three concussions should find another sport. Further, a severe concussion should automatically prohibit an athlete from participating in a contact sport forever.

One other caution: According to this article, ammonia should never be used to arouse an unconscious athlete. To do so may cause him to unconsciously jerk his head to avoid the smell - and that could lead to grave consequences if he has a cervical fracture.