Concussions are injuries that are invisible to the eye but warp the mind in a way that often takes weeks to recover and can permanently damage the brain. (Breslow) Still a medical mystery, doctors and scientists are working to learn more about the brain and the long term effects of head trauma. Since it is a developing scientific field, much is unknown about future effects because scientists have not had access to subjects in order to create and run a long-term case study. A previous study conducted in 1995 showed that 5.5% of all injuries, reported in high school athletics, during a three-year time period were concussions. (Powell) Since then, the concussion rate has grown immensely forcing the issue of concussion recovery and education to the forefront of political discussion. The NFL and the USA women's soccer team have helped make strides in promoting this as an issue that concerns the whole population instead of just high profile athletes. While politicians, professional athletes and scientists have a greater access to information about concussions, care and long term effects, young athletes that participate in high school programs and recreational leagues are often unaware and lack an athletic trainer to take care of them. For this reason, it is extremely important to have an increase in education for young athletes and families, in hopes of preventing long- term effects and increasing the rate of self- reported injuries. 

Scientists have drawn connections between concussions and long-term effects such as depression, suicide, and memory loss. One long-term effect, Chronic Traumatic Encephalopathy, is a condition that garners "loss of memory, difficulty controlling impulsive or erratic behavior, impaired judgment, behavioral disturbances including aggression and depression, difficult with balance, and a gradual onset of dementia" (BIRI) and is commonly diagnosed for those who have sustained a large amount of concussions or head trauma. Chronic Traumatic Encephalopathy, also known as CTE, is a disease that few know about but has claimed the life of several athletes and military personal. Over time this disease eats away at the brain, deteriorating it, leaving hole like marks that appear on CAT-scans. The youngest of which was Eric Pelly, shortly after his fourth concussion, playing high school football. He was only eighteen. Pelly's brain was donated to research and scientists were shocked to find traces of CTE, which is extremely unexpected at a high school level. His case drew attention to young athletes and the danger that they face. It raised awareness and concern that is usually focused on professional athletes. (Breslow) Since then, scientists have done more research on the brain, specifically the effect head trauma has on the hippocampus, which is the part that controls a person's memory. Studies show that athletes that had sustained concussions had hippocampi "that averaged just three quarters the size" of a person that had never suffered head trauma. (Seppa) Researchers are still determining the science behind why this is true, however they believe that a concussion causes cells "to rev into an excited state and eventually die". (Seppa) Neither of these long-term effects have cures yet, so it is important to spread awareness and help give young athletes the access to the care needed to recover from a concussion. A full recovery will decrease the likelihood of long-term side effects however "even a single concussion may cause lasting brain damage." (Flanagan) Every concussion leaves a mark on the brain so it is important to take the time to recover before its too late.

The dangerous, potential side effects of concussions give the impression that every athlete would take the time off to completely heal before returning to play. This does not happen because athletes even fail to report head injuries because they would rather play through the pain of a concussion than "[let] down their teammates, coaches, schools and parents". (Seppa) In fact a study by the University of Pennsylvania reported that out of athletes playing contact sports 27% of them have disguised concussions and concussion like symptoms to remain in the game. (De Lench) There are laws in every state "establishing mandatory protocols regarding issues such as removal from action, [and] return-to-play (RTP) procedures" as well as training for coaches and baseline concussion testing. (Green) These laws legally address what happens after a concussion has been diagnosed and outlines a detailed recovery plan but cannot inspire athletes to report concussions or seek medical help. These laws are ineffective if athletes do not report concussion like symptoms and submit themselves for a diagnosis. No real penalty is enforced by a governing body if a concussion is not documented and diagnosed. Therefor, there is no incentive to take time to recover because young athletes and parents do not know of the greater long-term effects that could manifest if a concussion is not properly cared for. 

It is not uncommon for high school athletes to hide concussions and concussion like symptoms because two years ago I did just that. It was my junior year of high school and lacrosse season was nearing the end. The championship game was three weeks away and there were six games that stood in the way of that victory and the title that the Collegiate girls lacrosse team had held for the previous nine years. Practice ramped up and drills were completed daily to the best of our abilities. The Monday before the next game, the team was running simple passing drills as a warm up to practice. It was my turn, and I ran forward to catch the fast approaching ball. However, I misjudged the distance and the ball collided with my nose. Startled and embarrassed I picked up the ball and finished the drill, ignoring the pain in my nose, cheek and head. The ball had come in contact with the bridge of my nose and faceguard with such a strong force the impact split skin on my cheek. I did not want to say anything to my coach because she was unapproachable and the injury seemed insignificant. I continued through practice with a headache, high emotions and in a bit of a daze. As a person who had four previous concussions in the past three years, I knew the symptoms of a concussion and that I was at a higher risk of sustaining one. I ignored the warning signs and my personal triggers for the next three days and played in two games as the symptoms continued to worsen. I had a lot to loose seeing as though it was my fifth concussion in three years and I would be required to stop all contact sports. I knew better than to hide it and yet I thought that I could hide my concussion and it would get better on its own. I was wrong. I did more damage to my brain in the week that I continued to push myself than I did in the initial impact. Friday morning, I was exhibiting loss of balance, uncontrolled emotion, severe headache, blurred vision and nausea. At this point, I had reached my limit and reported my concussion to the Athletic trainer at my school. The diagnosis was obvious, and I spent four weeks recovering, missed countless days of school and saw specialists at the Bon Secours and Redskins Concussion Clinic. 

I worked with neurologists and concussion specialists to regain my balance and eye tracking ability. They worked closely with the athletic trainers at Collegiate School to document my progress throughout the whole ordeal. The conscious choice I made to hide my symptoms set my recovery time back and did irreversible damage. Each of the five concussions I had during high school were unique and showed me different symptoms and side effects that I battled as I slowly made my recovery. I still get headaches and am unsure how my past concussions effect me on a daily basis and what will happen in the future. If I had known more about Chronic Traumatic Encephalopathy and other long-term side effects I would have made a different choice and reported my concussion immediately. 

There are a few misconceptions about concussions but the general lack of knowledge is concerning and cannot be blamed on the relatively young field. Most high school athletes do not have the access to qualified trainers and specialists. This means they are getting a lower quality of care which is unacceptable when dealing with something so precious as the brain. It is important to correctly diagnose, document all concussion related symptoms because "neurophysiological profiles may lead to greater success of the prevention of reinjury." (Powell) Limited access to care decreases the amount of knowledge and advice they receive about concussions which circles back to why athletes are not reporting concussions in the first place. Few people know about future issues like Chronic Traumatic Encephalopathy and memory loss because concussions are not common knowledge and accurate information on them is hard to find. Some athletes are even unaware of the symptoms of concussions and how to know if a concussion is suspected. One study defined a concussion as any "injuries for which the injured player was removed from participation and evaluated for a traumatic brain or head injury by the athletic trainer" however as stated above many cities do not have access to a trainer or a physician that can accurately treat a concussion. (Powell) A more general definition for Concussions are a head trauma that temporarily alters the brain so that a patient suffers from a change in personality and emotional state as well as memory loss, blurred vision and balance issues, among other symptoms.  

Those who believe concussions are a non issue and have been properly handled by the government could counter by saying that high school athletes and younger leagues are introduced to less forceful player on player contact and that is less likely to end in a concussion. (Hackney Publications) This is important to consider but overall irrelevant because studies have show "the importance of collisions, in all forms, as a contributing factor for [concussions] in sports". (Powell) In other words, it is not the speed or force of the impact but rather the way the contact was made. Another counter point is that many of the same long-term side effects of concussions and brain damage are also seen in people with a past use of steroids and other drugs. (Hackney Publication) This is only an area of concern in the NFL or other sports leagues. While young athletes my not have a history of drugs, high school students stuffer from a high amount of school related stress. Stress can have the same types of symptoms as concussions and trainers often use the Baseline Concussion Test to be sure. Stress causes students to be overly tired, emotional and in some cases nauseous. Athletes in youth and high school programs are unlikely to have a history of drugs and steroid use but it is common to be under a great deal of stress. However, this does not explain the drastic cases of CTE and suicide that have been documented in recent years. No, football will never be banned nor will sports become less aggressive, but technology innovations and changes to rules will help transform the sports culture. 

The large discrepancy between young athletes' access to knowledge and care is concerning and directly impacts the decision the player makes to report the injury or not. Current legal action is not doing enough to help the problem and is attacking the issue in the wrong way. Yes, the concussion legislation in every state enforces steps that need to be taken after a concussion is diagnosed but it does not provide a scale by which to diagnose the concussions nor does is provide a program that could help educate athletes and their families. An educational program or an online resource would be ideal in the fight to prevent long-term side effects by proper diagnosis and recovery.  

One way to distribute large quantities of information and make it accessible to the entirety of the US, would be to create a concussion education program that every athlete must complete. As of now, many high school athletes complete a Baseline Concussion Test which measures reaction time, memory and recognition. It provides a reference for trainers to know when players are fully recovered and ready to return to play. An athlete is usually not allowed to return to play until after his or her Baseline Concussion Test is back to normal. This additional test would function similar to Alcohol Edu in colleges nationwide. The online seminar program would give statistics, information on symptoms and long-term effects as well as ways to seek help if the athlete suspects they are injured. The general overview of information and resources would help level the discrepancies of knowledge that athletes face in different regions and backgrounds. No athlete should be at a greater risk than another due to access to medical care. Another solution would be to create a website geared towards parents with recent findings, resources and information on how to care for someone with a concussion. The concussion field is newer than some scientific fields so information is often outdated or hard to find. This website would be filtered to have relevant information for parents and athletes about concussions and what happens to a brain during a concussion. These resources will make parents and athletes more comfortable, knowing a little more about the injury and how best to treat it. The website would have a question forum for people to ask specialist specific questions case by case which would benefit those who do not have access to concussion facilities. Lastly, the best way to increase knowledge is to spread awareness. A social media and television campaign could reach all different types of people that may not know the long-term side effects and symptoms of concussions. This could help them seek medical attention for a concussion when they would not have otherwise. These three action steps will raise awareness and spread information to millions of people which will in tern raise the rates of self-reported concussions and decrease general misconceptions about the injury itself.

In conclusion, concussions are not rare but each case is unique in its severity and symptoms. Two people could be hit the same way, with the same force, and sustain two completely different types of injury. Concussions are specific to the patient and often no two concussions are alike even for the same person. This is why there is a large discrepancy about concussions because no one besides scientists and specialist, really know any hard facts. Lack of knowledge is as dangerous as false knowledge. This is why it is important to spread awareness and increase concussion education. Hundreds of concussions go undiagnosed and increase the injured player's risk for long-term damage. With the help of education, the rates will improve and more people will know about head trauma and how it is treated. Without an increase in access to education, athletes will remain unaware of the danger they could be in, if they continue to hide concussions.

