Gone are the days in which athletes who have been concussed take a couple days off then return to the playing field.Associated Press article, "Study: Football Concussions and Resuming Play Vary By Age," younger football players are more likely to return to the field less than a day after suffering concussions than those in high school and college.Local Efforts For Concussion PreventionStudying Concussions

Not that the old "rub some dirt on it and get back out there" attitude isn't still very much in place in the world of competitive athletics at all levels. But when it comes to head injuries, given all of the research, reports and advancements in technology, returns to the field take much longer than they used to.

When Newtown High School Athletic Trainer Sabrina Byrne sees an athlete who has suffered a concussion, she tells that player that he or she is looking at a four- to six-week recovery period before getting back to action.

But younger athletes may be returning to the field prematurely.

According to a recent

The report reads: "Only ten percent of young players with concussions resumed football that soon, but the results are concerning and suggest a need for more sidelines medical supervision and better recognition of concussion symptoms in children, said sports injury researcher Zachary Kerr, the lead author. He directs an injury surveillance program at Datalys Center for Sports Injury Research and Prevention, Inc, an independent group in Indianapolis."

In citing possible explanations for the study findings, Mr Kerr said that younger children may struggle to describe symptoms, and that health effects from concussions might not show up immediately.

Newtown High School uses ImPact, a computerized neurocognitive diagnostic tool, and has implemented a seven-day gradual return-to-play process in which the athlete, after being sign- and symptom-free (generally after a couple of weeks, Ms Byrne added), can begin the weeklong return-to-play program. The athlete begins on a stationary bike or walks on a treadmill, the intensity level increases and exercises - including balance and resistance routines - are added.

Just because the student-athlete has passed the return-to-play process does not necessarily mean he or she may resume play. The student must also be caught up academically, Ms Byrne noted.

"That's just because we feel they're students first, and then athletes," she said.

Much of the attention on sports concussions has focused on professional football and in college, but there is a need for more prevention efforts and research at all levels, including among the youngest players, Mr Kerr said in the article.

However, Newtown Youth Football & Cheer (NYFC) officials have been making significant efforts toward preventing concussions, as well as being prepared for other medical issues, notes Adam Carley, vice president of football for NYFC.

Mr Carley says NYFC coaches must be Connecticut Interscholastic Athletic Conference concussion training certified, be first aid and CPR certified, and are trained on how to prevent heat-related issues for players. An EMT is on hand at all youth games.

NYFC also uses Heads Up Football, a program developed by USA Football, to advance player safety in the game of football. This includes teaching proper tackling techniques in an effort to prevent head injuries. Newtown's youth program switched from the Colonial League to the Shoreline League three years ago, in part, because of Shoreline's implementation of Heads Up Football, Mr Carley said.

Mr Carley said referees will remove players from games if they do not tackle properly. In practices, coaches pull players from drills and reiterate the importance of proper tackling for safety, he added.

Although coaches spend time drawing up plays and preparing for the game aspect of football, there's a substantial amount of time devoted to injury prevention, Mr Carley noted.

"We spend as much time, as a board, with our coaches to make sure this is all in place - and there's no wiggle room," Mr Carley said.

Youth football concussions are rare, Mr Carley said, and he added that a system is in place to ensure concussed athletes remain sidelined until they should be back on the field.

"When we lose a player to a concussion we don't ever plan to see the player back for three to four weeks, and sometimes longer. That's something we follow to a T," said Mr Carley, adding that there is a slow process of getting players back into workouts and drills before they are at full speed once again.

Mr Carley has two children who play football, and he takes youth player safety very seriously.

Having coached at the high school level, played football at Western Connecticut State University and later coached at WestConn before joining the NYFC coaching staff in 2002, Mr Carley had been around football at a variety of levels for a long time.

"I've seen an enormous difference in terms of just being more aware of when a player suffers a blow to the head," Mr Carley said. "Coaches are more cognizant, more vigilant of the significance."

Mr Carley, a former defensive end and tackle, says he suffered a couple of concussions in high school and while playing college ball in the 1990s, and that he came back to play, undiagnosed in one instance, and much more quickly than the athletes of today do.

"I don't recall any sort of specific protocol in place back then," he said. "We've identified or diagnosed them a lot more than in the past."

Steve George, coach of Newtown High's football team, says that another tool being used, at the high school level, is protective helmet guards, which be believes prevent head injuries.

Mr George believes the Heads Up Tackling training is important for coaches and players as well.

"The benefits far outweigh the risk," said Mr George, pointing out that head injuries can occur in all athletic activities, including when somebody falls and hits their head on the ground.

Mr Carley believes football is a great opportunity for children to learn life lessons and gain valuable experiences, and wants children to be motivated to be involved.

"I hate to see kids move away from it," Mr Carley said.

At the same time, however, he acknowledges that very few players will go on to play at a high level, and is completely in favor of doing what it takes to prevent head injuries.

"Most of the kids we work with are going to need their brains a lot more going forward than they will need football," Mr Carley said.

Mr George and Mr Carley said the knowledge about concussion prevention had increased significantly throughout the years and both men believe the research and used of new techniques and resources are making for a safer atmosphere on the gridiron.

The Kerr study involved injuries reported by athletic trainers during practices and games from 2012 through 2014. The data included more than 200 programs at the youth, high school and college level. Youth teams involved players ages 5 to 14 in Pop Warner and USA Football programs. A total of 1,429 concussions were reported during the three seasons.

Concussions during games were most common in college players, averaging almost four per 1,000 games; the rate was two per 1,000 games among youth players and almost two per 1,000 among high school players. The rate in practices was less than one per 1,000 at all three levels.

The study also found differences in concussion symptoms depending on the ages of players. An average of about six symptoms occurred with concussions in college and high school players. Youth players had slightly fewer symptoms and were the least likely to lose consciousness, although blackouts were rare at all levels. Dizziness, headaches and loss of balance were among the most common symptoms at all levels.

College players were most likely to have amnesia and disorientation; high school players were most likely to have noise sensitivity and excessive drowsiness. Insomnia was more common among high school and college players, but rare at the youth level.

At all levels, most players were sidelined for at least a week. Time away from the sport of at least a month was most common among high school players - about 20 percent, versus 16 percent of youth players and seven percent of college players, according to the study. Less than one percent of high schoolers returned to play less than 24 hours after injury, compared with almost five percent of college players and ten percent of youth players.

The American Academy of Pediatrics and other doctor groups recommend that athletes avoid returning to play until all concussion symptoms have disappeared. The study notes that procedures for youth players required athletes to get a doctor's approval before returning to play.

Researchers say it is the first study to compare concussion symptoms and return-to-play times at all three levels.

"While the American Academy of Pediatrics and other doctor groups have recommended that athletes avoid returning to play until all concussion symptoms have disappeared, more recent studies indicate that parents and coaches may not realize that there are still concussion symptoms present that may be only evident with formal assessment or testing," said Dr William Begg of Newtown, vice chairman, Danbury Hospital Emergency Department, and EMS medical director, Danbury Hospital.

"Also, for those who have had resolution of concussion symptoms, there is still the need to have a rest period before returning to contact sports. The reason is, because if the child sustains the same injury to the head in a relatively short period of time after the first head injury, the child will have much more severe consequences, also known as second impact syndrome.

"Schools and youth sports organizations should have procedures for young players that require athletes to get a doctor's approval before returning to play," continued Dr Begg, who has been treating head injury patients for more than 25 years, has published national research on minor head trauma as the early as 1993 and wrote the most recent minor head injury policy for Danbury Hospital. Dr Begg was recognized as the 2016 Connecticut EMS Physician of the Year for his interest in pre-hospital care.

While studies and research have provided insight as to how to athletes and doctors handle concussions, they remain a mystery long term.

"We still don't know the full, long-term affect of this. We still don't know how many concussions are too many concussions," Ms Byrne says.