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. They know that concussions are becoming more prevalent and are increasing in severity. Younger players do not have access to professional trainers and are often unaware of the dangers of concussions. In order to save young athletes from permanent long-term damage that can arise from improper treatment, it is extremely important to have an increase in education for these athletes and their families. Concussions have become more prevalent and severe.  In order to stop the progression, we must make people aware of the dangers, educate student athletes and their parents, and listen to the personal stories of people like me.  

While the future effects are uncertain, neurologists have done studies on the frequency and severity of the head trauma and how it affects the brain in present day. One study conducted by a group of doctors in 1995, showed that 5.5% of all injuries reported in high school athletics, during a two-year time period, were concussions (Powell). Since then, the concussion rate has grown exponentially forcing the issue of concussion recovery and education to the forefront of the news cycle. Within the past year, 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. Both these sports are considered high impact sports and have the highest concussion rates (Powell). Some professional athletes, like Chris Borland of the San Francisco 49ers, retired after his rookie year due to the fear of permanent brain damage.  Similarly, athlete Brandi Chastain, an anti-concussion activist, promised to donate her brain to research on permanent damage done by head trauma (New York Times). These athletes have a greater access to information about concussions, care and long term effects, than the young athletes that participate in high school programs and recreational leagues. 

The fear of long-term side effects stems from the connections scientists and neurologists have drawn between concussions and depression, suicide, and memory loss. One proven long-term effect, Chronic Traumatic Encephalopathy, is a condition that garners a "loss of memory, difficulty controlling impulsive or erratic behavior, impaired judgment, behavioral disturbances including aggression and depression, difficulty with balance, and a gradual onset of dementia" (BIRI). It is commonly seen in brains that have sustained a large amount of concussions or head trauma. Chronic Traumatic Encephalopathy, also known as CTE, is a disease that few know of 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. This disease can manifest in any person who has had head trauma. One of the youngest was Eric Pelly, age 18, who died shortly after his fourth concussion, playing high school football. 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 (Breslow). His case drew attention to young athletes and the dangers that they face. It raised awareness for non professional athletes and opened discussion about changing rules to make sports safer. 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. A study by a neuropsychologist from the University of Nebraska, reveals that athletes that have previously sustained concussions had hippocampi "that averaged just three quarters the size" of a person that has never suffered from 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). Each concussion leaves a unique mark on the brain, so it is important to take the time to recover before it's too late.

Some say that high school athletes and younger leagues are introduced to less forceful player on player contact and therefore less at risk for permanent concussion damage and side effects than professional athletes (Hackney Publications). They suggest that no real damage could come from this kind of contact. This is important to consider, but overall irrelevant because studies have shown "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 thing to consider 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). An opposing view is that symptoms like depression, suicidal intentions and memory loss could be confused with a history of drug use. Research does not support this point in that a vast majority of victims of C.T.E and head trauma have not used drugs in the past due to sports restrictions and age. While young athletes may not have a history of drugs, high school students suffer from a large amount of school related stress. Stress can have the same types of symptoms as concussions, and trainers use the Baseline Concussion Test to be sure. Stress causes students to be overly tired, emotional and in some cases nauseous. While young athletes in high school programs are unlikely to have a past of drug and steroid use, 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, changes to rules and an increase of education will help transform the sport's culture. 

Side effects, such as the ones mentioned above should be taken seriously and steps should be taken to avoid them. The best way to prevent long-term damage is to take time off to make a full recovery. This does not happen because athletes 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 reports that out of all the athletes playing contact sports 27% of them have remained in the game despite a diagnosed concussion or concussion like symptoms (De Lench). There are laws in every state "establishing mandatory protocols regarding issues such as removal from action, [and] return-to-play (RTP) procedures", training for coaches and baseline concussion testing for athletes (Green). These laws legally address what happens after a concussion has been diagnosed.  It fails to 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 because they only focus on the recovery and return to play. No real penalty is enforced by a governing body if a concussion is not documented and diagnosed. Therefore, there is no incentive to take time to recover. This is why it is important to educate parents and young athletes so they can learn about the greater long-term effects that could manifest if a concussion is not properly cared for. With proper education athletes will be more motivated to report concussions and recover.

Most high school athletes do not have the access to qualified trainers and head trauma specialists that can provide them information. 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 and 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 a player receives 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 spot one. 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" (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.  However, as stated above many athletic programs do not have access to a trainer or a physician that can accurately diagnose and treat a concussion which puts the pressure on the athlete to self- diagnose.

I know the importance of education and access to proper care because two years ago, I suffered from my fifth concussion in my high school career. 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 between us and that victory. We were going for our tenth straight championship title win. 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 get worse. I had a lot to lose 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 by not telling someone 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. Had I known more about concussions and the permanent damage they have, I might have made a different decision. 

Friday morning, I was exhibiting a loss of balance, uncontrolled emotions, 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 and missed countless days of school. I saw specialists and neurologists at the Bon Secours and Redskins Concussion Clinic and even made a trip to the hospital. Each doctor chastised me for not reporting my injury sooner and told me about the damage that could have been avoided.

My concussion altered my emotions, eyesight and balance. Symptoms persisted for several weeks and I was instructed to stay in bed and rest. After my major side effects healed, I worked with neurologists and concussion specialists to regain my balance and eye tracking abilities. They worked closely with the athletic trainers at Collegiate School to document my progress throughout the whole ordeal. My trainer and I created a plan for me to follow and I progressed a little each day. I was lucky to have access to such incredible care that others in my situation are not privy to. The conscious choice I made to hide my symptoms set my recovery time back and did irreversible damage. I am now at a greater risk for C.T.E, if I don't already have it. The neurologists kept in touch and I have a two-year checkup soon. I still get headaches and can see how my memory has changed a little. I learn more about concussions each day and fear for what long-term side effects I could have.  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. This is why I believe that education is the best way to combat this issue in young athletes.

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 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. This is why education is important because knowledgeable athletes can take an active role in their diagnosis and recovery. Hundreds of concussions go undiagnosed because players either do not know the symptoms, or believe they can play through it. Education is the only way to save young athletes from permanent, long-term damage that can arise from improper treatment. It is extremely important to have an increase in education because it will promote an increase in the rate of self- reported injuries and a greater awareness of the danger of head trauma. Without an awareness of the danger, education for parents and athletes and real life testimonials, athletes will continue to suffer the life-changing consequences.

