“Don’t Tell Coach”: Kids Are Risking Their Health by Hiding Concussions

A child experiencing a concussion while playing sports is a very frightening, and all-too-common occurrence. What’s even more frightening is that after receiving such a serious injury, many youth athletes do not receive proper treatment for their concussions. In fact, many youth athletes put themselves at risk of permanent impairment from re-injury by continuing to play their sport while suffering from the effects of a concussion.

A concussion is a traumatic brain injury “caused by a bump, blow, or jolt to the head and brain that causes the head and brain to move rapidly back and forth. This sudden movement can cause the brain to bounce around or twist in the skull, creating chemical changes in the brain and sometimes stretching and damaging brain cells” (Centers for Disease Control [CDC]). And the symptoms of a concussion can be scary: Nausea, slurred speech, a headache that doesn’t go away, convulsions, confusion, and loss of consciousness, among other symptoms (CDC).

Between 1.1 and 1.9 million minors in the United States experience concussions while participating in organized sports and recreational activities each year, according to a study published last year in Pediatrics, the official journal of the American Academy of Pediatrics (Bryan). While people tend to think of football when the subject of sports-related concussions comes up, athletes in a variety of sports are at risk. In fact, studies show that young female athletes experience concussions at higher rates than their male counterparts (Women’s Sports Safety Initiative),

There is widespread agreement that, for their own protection, youth athletes experiencing concussions should be closely monitored, and have ample time for rest and recovery before being allowed to return to full activity in their chosen sport. All 50 states and the District of Columbia have enacted legislation to address the consequences of youth sports-related concussions, the vast majority of which establish requirements for evaluation and clearance by some sort of health care provider, ranging from physician to athletic trainer, before the athlete returns to play.

So why are young athletes who have experienced concussions continuing to play their sports, and not receiving the rest and medical attention that it is so widely agreed upon that they need?

The problem is twofold: the adults in charge of the athletic activity not recognizing the signs of a concussion, and the student athletes hiding those signs from the adults responsible for their wellbeing.

While a concussion is potentially a more serious injury than a broken leg, given the possible long-term consequences, it is not as obvious an injury. A coach will not necessarily be able to spot common symptoms like nausea, headache, and blurred vision, and many symptoms of a concussion will not appear until hours after the initial injury, when the young athlete is far away from coaches and trainers.

While most states require athletic trainers to be educated about concussions, not all student athletes have access to an athletic trainer, and the majority of states do not require the same of athletic coaches. This is why former California legislator Mary Hayashi authored a bill mandating that school athletic coaches have formal training on how to identify a concussion, and believes that “we need the legislature of each state to add this criterion to their current athletic guidelines.” As of the beginning of 2017, 21 states have done so (Women’s Sports Safety Initiative).

Identifying a concussion in a student athlete should be an easier task for both coaches and athletic trainer than it is in practice. One would think that any athlete experiencing the symptoms of a concussion would seek help and let an adult authority figure know. But this is all-too-frequently not the case—research suggests that around half of high school athletes may not report a concussion to an authority figure (Wallace).

Don't Tell Coach

 

Why would a young athlete put their well-being at risk by trying to hide a traumatic head injury? 

Three studies have produced similar results in determining the most common reasons student athletes fail to report their symptoms of concussion:
1. They didn’t think the injury was serious
2. They did not want to lose playing time
3. They didn’t want to let their team down (Wallace).

A recent study conducted by researchers at Youngstown State University and Michigan State University and published in the Journal of Athletic Training sought to examine whether access to an athletic trainer might impact the rate at which student athletes self-reported their concussion symptoms. But while the study did find that those with access to an athletic trainer demonstrated significantly better knowledge about concussions and their symptoms, they did not, in fact, self-report their head injuries at a significantly different rate from those athletes without access to an athletic trainer (Wallace).

“Concussions that are unidentified and underreported can increase the risk of subsequent injury and long-term consequences in the adolescent athlete” (Wallace), which is why something needs to be done about the high rate at which student athletes fail to report their symptoms to adult authority figures.

“Barriers to concussion reporting by athletes need to be resolved, with an emphasis not only on education and knowledge, but also the pressures that athletes face from peers, adults, and their own perceptions,” says Dr. Zachary Kerr, a researcher in the Department of Exercise and Sport Science at the University of North Carolina at Chapel Hill (cited in Leehman).

Dr. Jessica Wallace, a researcher at Youngstown State University, has a specific suggestion on how to increase the reporting of concussion symptoms in youth athletes: the buddy system. “Often, athletes will not report their own concussion, but they will be mindful and protective of their teammates. So the ‘buddy system’ would help me as the athletic trainer because the athletes would come and tell me if they thought their teammate/friend was experiencing a concussion or concussion symptoms” (cited in Leehman).

Policy makers have made good progress in recent years in enacting legislation to help protect our young girls and boys in student athletic programs from concussions and the long-term impacts that untreated and multiple concussions can have on them, while still letting the kids play their sports. But the current research demonstrates that the problem should be looked at from an additional angle to further accomplish this goal—getting the youth athletes themselves to participate more frequently in helping coaches and athletic trainers to protect them. Researchers, school administrators, and policy makers should take note that they need to incorporate another approach in their efforts to let girls and boys participate in sports without subjecting them to avoidable risks of serious head injuries.

Sources:

Bryan, MA, Rowhani-Rahbar A, Comstock RD, et al. Sports- and Recreation-Related Concussions in US Youth. Pediatrics. 2016;138(1):e20154635

Centers for Disease Control and Prevention. “What Are the Signs and Symptoms of Concussion?” Retrieved June 6, 2017, from
https://www.cdc.gov/traumaticbraininjury/symptoms.html

Centers for Disease Control and Prevention. “What Is a Concussion?” Retrieved June 6, 2017, from https://www.cdc.gov/headsup/basics/concussion_whatis.html

Leehman, Shereen. “High school boys fear looking ‘weak’ if they report concussions.” Retrieved June 6, 2017, from http://mobile.reuters.com/article/idUSKBN18T2RR

Wallace, Jessica, et al. “Knowledge of concussion and reporting behaviors in high school athletes with or without access to an athletic trainer.” Journal of Athletic Training, vol. 52, no. 3, 2017, p. 228+. Retrieved June 30, 2017, from http://natajournals.org/doi/10.4085/1062-6050-52.1.07?code=nata-site

Women’s Sports Safety Initiative. Sports Related Concussions: Changing the game for women and sports. Retrieved March 6, 2017, from http://womenssportssafety.com/wp-content/uploads/WSSI-Report-FINAL.pdf

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