For many, participating in sports is a pivotal part of growing up. From recreational sports that parents signed their children up for to varsity teams in high school, these extracurricular activities help children develop social skills while staying active. While contact sports are a large part in many adolescents’ lives, the once innocent sports played in parks can quickly turn dangerous. Injuries that were overlooked for years and which are still often ignored are concussions. Even though recently Hollywood has shined a light on the subject, many times the hidden dangers of repeated concussions is ignored. In order to protect athletes at all levels, a revised protocol that places more emphasis on their wellbeing must be implemented. 

A concussion is a temporary unconsciousness caused by a blow to the head and is a term that can also be used loosely to describe short term confusion or incapacity (Cunha and Stoppler). It is a type of traumatic brain injury that occurs when an individual is struck in the head, creating a change in chemistry in the brain that can often damage brain cells (Cunha and Stoppler). Cerebrospinal fluid, also known as CSF, is found in the head and has the primary purpose of protecting the brain. When the head is hit hard enough, the CSF can’t protect the brain from colliding with the skull (Lichi and Bandar). The brain reacts in a similar manner to other tissues in the body and swells due to the collision with the skull. The swelling in the brain is problematic because the skull does not have space for the brain to swell inside of it. The intracranial pressure that results from the swelling of the brain causes the injury to the brain to become more severe and causes more symptoms to emerge (Lichi and Bandar).

Although typically not life threatening, concussions are a serious matter that are often under diagnosed. After the initial impact to the head, many signs and symptoms can reveal the onset of a concussion including the inability to recall certain events, off balance movement, headaches, nausea or vomiting, and rapid mood changes (“Centers for Disease Control and Prevention”). There are very limited options for treatment of a concussion. The best way to recover from a concussion is rest until all symptoms are gone, both while stationary and while exercising. A person with a concussion needs to avoid all strenuous activities such as running and activities that engage the brain such as viewing a phone screen. Every concussion is different and the recovery time will vary from person to person significantly, with symptoms from the most severe concussions lasting for a year or longer. Concussions are very challenging to be properly diagnosed. They do not show up on scans or x-rays in the same manner as other traumatic brain injuries such as brain bleeds. Another reason that they are often treated as less severe as they really are is due to the fact that some symptoms do not show up for seven to 10 days (Pruthi). Professionals are learning more and more about concussions and the recovery from brain injuries every day. Recently, “researchers...found that patients who engaged in the most mental activity took about 100 days to completely recover, having no headaches, dizziness or blurred vision. For those who gave their brains time to heal, recovery time was cut to an average of 43 days” (Pruthi). 

During any given year, there are approximately 36,250,000 children between the ages of five and eighteen that are involved in organized sports (Harden). The number of participants in sports decline as the sport becomes more competitive and time consuming. With the rising level of competition, the number of injuries and the severity of those injuries rises as well. Two of the most popular sports in high schools around the United States are football, men’s soccer, and women’s soccer, with 1,200,000, 538,676, and 433,120 participating respectively. A 2013 study performed by the National Federation of State High School Associations found that 23.1% of all injuries reported in high school athletes are concussions (Colorado School of Public Health). Around 78% of all concussion sustained by athletes occur in game situations, with 22% occurring during practice (Strickland). For males, football players have the highest risk of sustaining a concussion with around a 75% chance. On average, players have an impact speed of twenty-five mph when they tackle each other. This activity is when the majority of concussions are sustained in football. For females, soccer poses the highest risk with 50% of players suffering from a concussion at some point (Strickland). When a soccer player heads the balls, the ball has an impact speed of 75 mph. Seventy-five mph is faster than many cars travel while driving on highways and thus can cause significant trauma to be experienced by the player heading the ball. 

Concussions are especially challenging to diagnose in athletes because they notoriously attempt to “play through the pain” and lie about the severity of the symptoms that they are experiencing. This can result in athletes suffering from repeated blows to the head before the brain has fully healed from the initial blow that resulted in the concussion. This can prolong the symptoms that an athlete is experiencing and often make them worse. A study performed at the Cincinnati Children’s Hospital surveyed 119 high school football players. The participants were asked about their knowledge of concussions and the risks associated with not taking the injury seriously. 92% of the players were aware that they “risked serious injury if they returned to the field too quickly after a concussion” (Hoffman). Despite this knowledge and understanding, “only 54% said they would report such symptoms to their coach” (Hoffman) and 53% said that they would continue to play while suffering from symptoms of a concussion.

A major reason why concussion symptoms are under-reported is due to the pressures placed on athletes by their coaches.  Dustin J. Fink, who served as an athletic trainer for various high schools was quoted saying “I’ve seen coaches who tried to be the decision-maker with injuries. They need that win, so they will try to override the athletic trainer or manipulate the athlete to get back in the game” (Hoffman). Coaches have been known to place the success of their season over the health of their players.

While coaches do put pressure on their players to play through the pain, there are players that hide their symptoms from concerned coaches. Zac Easter grew up in a small town where kids peak during their time on the high school football team. Easter loved football but was not physically ideal for the sport so he learned to compensate by tackling harder than anyone else on the team. After years of playing and sustaining repeated concussions, Easter eventually killed himself after suffering from Chronic Traumatic Encephalopathy, also known as CTE. CTE is a progressive disease, affecting the brain of people who have suffered repeated concussions.  Individuals who develop chronic traumatic encephalopathy will experience a gradual deterioration in the brain and an eventual loss of brain mass after passage of time (Bailes). Before he committed suicide, Easter wrote journals detailing his suffering and how he lost control over his body and mind. In one of the journals, Easter wrote “My dad was an intimidating hard ass football coach and the Easter mentality meant that we were supposed to always be tough as nails, show no weakness, and never get taken out of game for being hurt” (Nelson). Easter would repeated lie to coaches and hide his symptoms in order to keep playing because he felt like he had something to prove to not only his coaches, but his parents. The mentality of players where they feel like they are invincible is problematic and results in severe and permanent brain damage all so that they can play in a game that will not matter in ten years. 

While both coaches and players are able to be overzealous about their return to the game after a head injury, the blame can’t always be placed on them. Until very recently, concussions were thought of a nuisance that took valuable players out of games. A prime factor in people doubting the severity of them is the inability of medical professionals to prove that something does actually happen to the brain when the head gets hit. When referring to student-athletes, the fact of the matter is that student comes before athlete. Repeated head injuries hinder students’ ability to focus in class and this succeed in school. In 2006, schools and hospitals began using ImPACT testing on student athletes. The test consists of a baseline exam that measures an individual’s neurocognitive strength. ImPACT testing is a way to diagnose and treat brain injuries before they become serious problems. ImPACT testing involves a “a computerized neurocognitive assessment tool to help licensed health care providers evaluate and manage a suspected concussion” (“ImPACT Test”). If an athlete receives a blow to the head and experiences the early symptoms of a concussion, they are required to take the ImPACT test again. The results from the second time they take the test are compared to their baseline score. These data scores provide medical professionals with definitive proof that the neurogenetic abilities of the brain have been temporarily compromised and the athlete has a concussion. 

Currently, the NFL has a four-step process required for each player to complete before they are cleared. This process is emerging in many high schools in their post-concussion treatment. The four-step process begins with a neuropsychological exam by a certified consultant who then reports the results back to the team physician. The player is required to make a gradual return to practices and games and must be cleared by the team physician and the Independent Neurological Consultant before granted access to play again. This consultant must have expertise in concussions and may need to evaluate the player multiple times before allowing him to return to game play (Weinfuss). The only way a player can be completely cleared is after returning to baseline status and resting for an extensive period of time (Weinfuss). This protocol is controversial because sometimes the baseline test is not always reliable.

While ImPACT testing has been extremely valuable in the diagnosis of concussions, it lacks the ability to tell how long the recovery time will be. Despite athletes returning to their baseline scores, the brain is not necessary done healing. On average, an athlete will miss between 10 and 16 days when they suffer from a concussion. This number is significantly lower than the accepted average of 43 days that it takes a brain to fully recover from a concussion if the affected actually focuses on their rest and recovery. While ImPACT testing has been helpful in diagnosing concussions in athletes, by the time that they are needed to be tested, the damage to the brain has already been done. 

One step that designers of sporting equipment are taking to prevent concussions are designing helmets that better protect the head and brain from hits. The helmet is arguably the most important piece of equipment worn on the field but if not worn properly, its purpose is not served. Helmets must be well maintained, be age appropriate, be worn consistently and correctly, and be certified for use (Centers for Disease Control and Prevention). No helmet can protect the head from all injury but if used correctly, a helmet can greatly decrease the risk of head and neck injuries.

A means of protocol that has primarily made its way into the college football world is the rule of targeting. According to National College Athletic Association rules, targeting is defined as “initiating contact to the head or neck area of a defenseless player” (Weinfuss). This rule was put into place to reduce concussion risk in athletes of all ages. Although this rule is in place to protect the well-being of players and help prevent injury, many sports fans are not on board with it because of the sometimes accidental helmet to helmet contact that takes place when the defense is tackling an opponent. The targeting rule requires the individual who completed the misdemeanor to be ejected from the game and immediately taken into the locker room. Again, whether the contact was intentional or not, the rule stands (Weinfuss).

An explanation for this targeting rule includes the multiple deaths of football players due to extreme concussions and other head injuries. A sixteen-year-old boy died after a head on collision during a football game, becoming the third high school player in the United States to die in a week in 2014. This has raised a lot of concern nationwide for people of all ages participating in not only football but all contact sports. In 2013, 1.24 million children were seen in the emergency room for sports related injuries, pushing many states to make rules for the youth football leagues such as requiring a child to sit out after taking a hard hit (Pilon). These rules are in place to prevent accidents like these from happening and to stop head injuries that can lead to potential developmental damage in the future. 

If a concussion is not immediately taken care of or gets too severe, a Traumatic Brain Injury (TBI) can develop. There are many consequences to these injuries but they usually are not noticeable until six or more months after the injury occurs. Some of these problems include seizures, visual disturbances, depression, psychosis, and progressive dementia (Centers for Disease Control and Prevention). All of these issues can cause severe damage to the developing body if not properly treated. It is vital for athletes to be aware of the recovery time and treatment process of head injuries in order to be able to better take care of themselves in the long run.

While rules are beginning to develop in sports to help promote the health and safety of all athletes, there are still not enough. There should be a revised protocol such as the one currently in place in the NFL in all middle schools, high schools, and colleges in order to protect kids and adolescents from developing future physical and cognitive damage. These rules are in place to help prevent a serious rising problem seen in all contact sports and to defend athletes from exposure to current and future damage. The risk of injury to the point of death is something that can be prevented with the proper use of equipment and knowledge of recovery time and treatment. The ImPACT test should be used in all schools and every child and adolescent should be required to take a baseline test before participating in any contact sports. Young athletes and their parents should also be required to attend a class about safety and precautionary measures used in sports before participating. With the use of this protocol and the implementation of rules regarding safety, this growing problem of concussions and head injuries leading to traumatic brain injuries and further developmental problems could be stopped for good.
