Along with hard hits come the hard tasks of identifying concussions and deciding when to clear players for returning to normal routines.

Gary Solomon, the consulting neuropsychologist for the Tennessee Titans and team neuropsychologist for the Nashville Predators, puts this into perspective.

“We can replace your hip, and we can get you a new knee, but we can’t get you a new brain,” he said.

The challenges for team doctors and trainers come from many different directions. The NCAA offers neither rules on how much time trainers must allow before clearing a player nor punishments for early returns. It doesn’t favor a tool for assessment and diagnosis.

Western’s sports medicine team, like many teams nationally, uses a Standardized Assessment of Concussion test, called SAC, which checks for physical symptoms and measures functions such as orientation, Head Athletic Trainer Bill Edwards said.

Two certified trainers can conduct the test on the sideline when staff suspect a concussion. In most cases, the test relies on player awareness and honesty about their symptoms. Experts endorse the test for sideline use, and it meets recommendations of the NCAA and many published guidelines.

But after diagnosis, trainers face another challenge: when to return a player after they’ve suffered a concussion.

That subject is controversial. But the method of treatment is not: rest.

Guidelines recommend a period of seven days symptom-free before clearing a player for contact, and increased periods of rest for subsequent concussions.

Edwards said players at Western have to be clear of symptoms for 24 hours. They gradually increase exercise and do drills without contact as long as they don’t display symptoms. Then a team physician, usually orthopedist Craig Beard, will clear the player.

After a player gets a concussion, Edwards said he conducts the SAC test a few hours later and daily until players are symptom-free.

But those examinations largely depend on player cooperation, and numerous studies show that players under-report concussions at every level of play.

Junior quarterback David Wolke told trainers he felt fine the day of his injury. He continued to do so in follow-up examinations. He was able to pass memory tests, even though he was continuing to have trouble with his memory, he said later.

“I’m just really good at cramming,” Wolke said jokingly about the tests.

The medical staff at Western knows about the seven-day waiting period recommended by guidelines, but doesn’t always follow them because researchers don’t agree on them, Beard said.

“I think you can’t box yourself into absolutes,” he said.

Beard said the decision to return at Western is based on the severity of a player’s symptoms, medical history and position.

Some players can recover quickly, Solomon said. But the decision to clear a player needs to be correct, he and other experts say.

The risks that come with a wrong decision are dire.

Most symptoms pass between seven and 10 days, according to a 2003 study of 2,905 football players at 25 colleges. Kevin Guskiewicz, director of the sports medicine research laboratory at the University of North Carolina-Chapel Hill, and his colleagues conducted the study.

But there is paradox in concussion treatment.

While longer periods of rest likely ensure recovery, they present another problem: If players automatically get pulled from play for coming forward with symptoms, they might not do it.

That’s part of why Solomon doesn’t advocate a mandatory minimum symptom-free period.

“You may be unnecessarily penalizing a guy, because concussions are so individual,” he said.

In games, players at Western who are free of symptoms in less than 15 minutes can often return to play, Edwards said. Any longer and he refers them to a physician.

In practice, a player will have to sit out for any suspected concussion, because physicians don’t come to practice, Edwards said.

Chris Nowinski, a Harvard-educated pro-wrestler whose career ended because of concussions, finds the “15-minute” rule misleading. Studies show that many symptoms emerge late.

Contact needs to be monitored before a game in a controlled environment, said Jamie Pardini, a neuropsychologist at the University of Pittsburgh who specializes in sports medicine. Hits in games tend to be harder, and the fast-paced nature of a game makes it harder to catch an injury.

The athletic training department bought the Immediate Post-concussion Assessment and Cognitive Program, called ImPACT, which is a computerized test that evaluates cognitive skills such as memory, processing speed and reaction time.

The aim was to more accurately follow a players’ recovery.

“Given what I’m seeing,” Beard said. “I’m sure we let some kids back before we should have.”

By Oct. 23, “three or four players” had been benched because of test results that indicated a concussion, Beard said. By Oct. 31, 61 Western players had taken the test, and 11 of them were injured, records show.

To be most accurate, uninjured scores (called baselines) are needed for comparison, Pardini said. Usually they are collected preseason.

Western doesn’t have baselines because it bought the test midseason.

Solomon, who uses the tests, said relying on midseason baseline scores was “not smart,” but “better than not at all.”

“First of all, they’ve already sustained hits,” he said. “You’re not getting a clean baseline.”

Pardini, who helps teams implement ImPACT and whose colleagues designed it, said scores can still be evaluated by comparison to national averages.

The test is a good resource but doesn’t replace a person, preferably a neuropsychologist, Pardini said. Neuropsychologists specialize in cognitive function and can assist with diagnosis, something ImPACT isn’t designed to do. They also can spot lying, she said.

Still, a certified trainer and physician with continued educations on brain injury should be enough, Nowinski said.

Beard said he’s dealt with concussions for about 20 years.

“I feel very comfortable dealing with them,” he said. “If not we send them to a neurologist.”

Reach Corey Paul at news@chherald.com.