Even to people who are ill-informed about the long-term effects of concussions, it’s hard to deny the seriousness of a concussion, and the danger associated with continuing to play with one. The amount of information discovered in recent years about these effects has been published and publicized, while athletic programs throughout the country have enacted rules and regulations regarding continued activities when a concussion is identified.

Identification is the key. Has the injury been assessed, reported and correctly diagnosed, or is the athlete, coach or even the parent keeping quiet? Even with the knowledge and education available, there still appears to be a reluctance of the athletes to report symptoms of a concussion during competition. Although athletic trainers and other medical personnel are available to provide assessment and concussion diagnosis at most games, there are many others where they are not. Making the matter worse is the fact that most concussions occur during practice where medical professionals are less likely to be present. Unless concussion assessment methods become ubiquitous, players will continue to be subjected to additional and more severe injuries if they continue to play.

While it’s clear that a trained medical professional (Athletic Trainer, Nurse or Physician) is the best one to make the determination of a possible concussion or brain injury, it is often the player who needs to share potential symptoms or teammate who need to report a possible hard impact. Although some symptoms may be visible to the health care professional such as balance or nausea, other symptoms such as general fogginess or concentration issues may not be. It is crucial that the athlete is not only aware of the perilous nature of a brain injury but also willing to put their health above the game. Recent studies show that many times the athlete will not put their brain health above the sport.

1In a recent anonymous online survey of collegiate athletes, they revealed that despite increased concussion education, today, roughly the same degree of underreporting of concussion as in 2004.

Researchers at the University of Pennsylvania reported that among all varsity athletes who responded within two weeks to an e-mail from Penn’s head athletic trainer:

  • 27% of athletes who self-identified as playing contact sports said they had hidden a concussion to stay in a game compared with 14% of athletes in noncontact sports;
  • 54% of contact athletes stated that they would be extremely unlikely or unlikely to report a concussion in a game situation; and
  • 30% of noncontact athletes said they were likely or extremely likely to report a concussion versus 20% for contact athletes.

2“These findings were present despite strong educational efforts and knowledge of concussion symptoms among respondents and suggested that even educated athletes may not have changed their attitudes toward reporting concussions,” the study noted.

A May 2013 study by researchers at Cincinnati Children’s Hospital determined that out of 120 high school football players, one-quarter of them had suffered a concussion. The good news was that three-quarters of those surveyed (82 out of 120) reported receiving prior concussion education and that most could correctly recognize the principal symptoms of a concussion:

  • Headache (93.3%)
  • Dizziness (89.2%)
  • Difficulty remembering (78.3%)
  • Sensitivity to light/sound (78.3%)
  • Difficulty concentrating (75.8%)
  • Feeling in a fog (52.5%)

Also encouraging was that 9 out of 10 recognized the risk of serious injury if they returned to play too quickly.

But here’s the bad news:

  • An astounding 91 percent felt that it was okay for an athlete to play with a concussion
  • 75 percent said they would play through any injury to win a game
  • 53 percent stated that they would “always or sometimes continue to play with a headache sustained from an injury,”
  • Only 54 percent would “always or sometimes report symptoms of a concussion to their coach,” and
  • Only 4 in 10 would tell their coach immediately if they had concussion symptoms.

Most recently, a study at Wake Forest, the University of North Carolina (Chapel Hill), and A.T. Still University found that there is a “gross underreporting” of concussion incidents, with a large proportion of those surveyed indicating that they continued to participate in both games and practices while experiencing symptoms.

Consistent with the other studies, the reasons athletes gave for not reporting possible concussions were that they:

  • Did not think the injury was serious enough to report (70.2%);
  • Did not want to be removed from the game (36.5%);
  • Did not want to let down teammates (27.0%)
  • Did not want to let down coaches (23.0%);
  • Did not know the event was a concussion (14.9%); or
  • Did not want to be removed from practice (13.5%).

So while great strides have been made regarding understanding the impact of concussions and the severe nature of an athlete continuing to play with one, it seems evident that the athletes don’t appear to recognize the seriousness of their situation, ss shown in the statistics above. There are a variety of reasons cited by the athletes, and it may take a while for them to change their mindset.

But why? Do they not believe the information they’ve heard? Have the number of hits they’ve already taken made them feeble-minded? Or are they just crazy?

Chances are, it’s not any of those reasons. A lot of this machismo most likely goes back a long way, to the culture of the game they play. Aren’t they just exhibiting behavior that other athletes have shown ever since their sports have been around? Getting your “bell rung” on a football field was always par for the course. And players who returned to the game to help their team win the big game were considered heroes.

Also, players who participate in contact sports such as football, hockey, and soccer, need a certain amount of toughness and machismo to excel. So what will your teammates think if you can’t toughen up and return from a hard hit, even if you don’t feel just right? Team sports also have a tendency to make you accountable not just to your coaches, but also to your teammates. Letting any of them down by not returning can cause the player feel like they are not as valuable or important to those who are counting on him.

And going back to culture, unless you had a physical injury like a broken bone or had to be dragged off the field, you were expected to be out there for your team. Which is why the culture of these games may be one of the most difficult things to change. In today’s win at all cost environment, I don’t see it coming from teams or coaches. Programs that win will get more attention and coaches who win will get to keep their jobs. And they rely on their players to get those wins.

From a player’s perspective, there is also a lot on the line. While many feel they need to be on the field and excel to get that scholarship, others may look at it to fuel their self-worth and popularity among their peers. Therefore, the value they put on the games and being out on the field, appear to them to be much more important at the time than their long-term health. In retrospect, they will probably look back and see how simple-minded they actually were by not reporting their symptoms and returning to action, but in the moment they felt they were doing the right thing.

Which is why taking the decision out of the players’ hands is the best long-term solution. While culture change could take a long time to take effect, and may never actually happen, athletic programs of all ages need to ramp up diagnosis, testing and rules and regulations in an attempt to protect the players. While it’s true that many programs have specific rules regarding “continued play” for a concussion sufferer, the means and frequency of assessment need to increase.

The need to have a trained athletic trainer or health care professional available at all contact sporting events would help. Sure, there are possible costs associated with this, but the long-term benefits of the young athletes would make it a cost worth the price.

Also, refined testing that would include tests for both cognitive and noncognitive injuries would also have significant benefits. Many times, a concussion is not diagnosed because all symptoms of the injury are not visible to observers. With a trained health care professional, a proactive approach could be taken with a player when it is noticed that they’ve taken a hard hit and appear to be affected. Early determination and prompt action are the keys to dealing with a concussion and in preventing additional and more damaging injuries.

Parents can also play a role in the overall education process for their children. Encouraging them to drop the machismo and to report any symptoms of an injury after a hard hit can also hopefully make a difference.

However, until their actual peers and role models, such as their teammates and coaches, make it clear that it’s okay to report their symptoms and take themselves out of practices and games, we will continue to see preventable brain damage. And that’s the most unfortunate part for everyone.



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