Concussion in High School Sports
Guide for Coaches
The Facts
-
A
concussion is a brain injury.
-
All
concussions are serious.
-
Concussions can occur without loss of consciousness.
-
Concussions can occur in any sport.
-
Recognition and proper management of concussions when they first
occur can help prevent further injury or even death.
Concussions
are sometimes called mild traumatic brain injuries (MTBI). They are
caused by a bump, blow, or jolt to the head. Concussions can occur in
any sport, including these:1, 2
Baseball |
Gymnastics |
Softball |
Basketball |
Ice Hockey |
Volleyball |
Field Hockey |
Lacrosse |
Wrestling |
Football |
Soccer |
|
The potential
for concussions is greatest in athletic environments where collisions
are common.3 Environmental factors also can cause injury. For
example, a player may collide with an unpadded goalpost or trip on an
uneven playing surface.
Sometimes people do not recognize that a bump, blow, or jolt to the head
can cause a concussion. As a result, athletes may receive no medical
care at the time of the injury, but they may later report symptoms such
as headache and dizziness. These symptoms can be a sign of a concussion.4
-
An
estimated 300,000 sports- and recreation-related head injuries of
mild to moderate severity occur in the United States each year.5
Most can be classified as concussions.
-
Collegiate
and high school football players who have had at least one
concussion are at an increased risk for another concussion.6, 7
-
A repeat
concussion that occurs before the brain recovers from the
first—usually within a short period of time (hours, days, or
weeks)—reportedly can result in brain swelling, permanent brain
damage, and even death. This condition is called second impact
syndrome.8, 9
Signs and Symptoms
One or more of
these signs and symptoms may indicate that a concussion has occurred.10
Remember that concussions can also occur with no obvious signs or
symptoms. Any of the symptoms listed in this table should be taken
seriously. Athletes who experience these signs or symptoms after a bump,
blow, or jolt to the head should be kept from play until cleared by a
health care professional.
SIGNS OBSERVED BY COACHING STAFF |
|
SYMPTOMS REPORTED BY ATHLETE |
Appears dazed or
stunned |
|
Headache |
Is confused about
assignment |
|
Nausea |
Forgets plays |
|
Balance problems or
dizziness |
Is unsure of game,
score, or opponent |
|
Double or fuzzy vision |
Moves clumsily
|
|
Sensitivity to light or
noise |
Answers questions
slowly |
|
Feeling sluggish |
Loses consciousness |
|
Feeling foggy or groggy |
Shows
behavior or personality changes |
|
Concentration or memory problems |
Can’t recall events
prior to hit |
|
Confusion |
Can’t recall events
after hit |
|
Prevention and Preparation
As a coach, you can play a key role in preventing concussions and
managing them properly when they occur. Here are some steps you can take
to ensure the best outcome for your athletes, the team, and the school:
Educate the school community about concussion. Tell athletes,
their parents, and other school officials about the dangers and
potential long-term consequences of concussion. Make sure athletes,
their parents, and school officials:
-
Can
recognize signs and symptoms of concussion.
-
Withhold
athletes from play until a health care professional has evaluated
and cleared their return.
-
Know to
take all signs and symptoms of concussion seriously.
-
Inform
coaching staff if an athlete receives a blow to the head,
experiences symptoms of concussion, or behaves out of the ordinary.
Coordinate
with other school officials. Involve other school officials—such as
principals, certified athletic trainers, other coaches, school nurses,
and parent-teacher associations—to ensure that school rules and policies
support concussion prevention and management strategies.
Insist that safety comes first. Teach athletes safe playing
techniques and encourage them to follow the rules of play. Discourage
all unsportsmanlike conduct and support strict officiating of games.
Make sure athletes wear the right protective equipment for their
activity (such as helmets, padding, shin guards, and eye and mouth
guards). Protective equipment should fit properly, be well maintained,
and be worn consistently and correctly.
Teach athletes that it’s not smart to play injured. Sometimes
players, parents, and other school officials wrongly believe that it
shows strength and courage to play injured. Discourage others from
pressuring injured athletes to play. Don’t let athletes persuade you
that they’re “just fine” after they have sustained any bump, blow, or
jolt to the head.
Prevent second impact syndrome. Keep athletes with known or
suspected concussion from play until appropriate medical personnel have
evaluated them and have provided permission for returning to play.
Remind your athletes: It’s better to miss one game than the whole
season.
Prepare for concussions year-round. There are actions you can
take throughout the school year that may help prevent concussions. For
example:
Preseason
-
Ensure
that players are medically evaluated and are in good condition to
participate.
-
Establish
an action plan for handling concussions that occur. Be sure that
other appropriate school officials know about your action plan and
have been trained in its use. (See “Create an Action Plan,” page
10.)
-
Explain
your concerns and expectations about concussion and safe play to
athletes and school officials.
-
Ask if
players have had one or more concussions during the previous season.
-
Remind
athletes to tell coaching staff if they suspect that a teammate has
a concussion.
-
Determine
whether your school would consider conducting preseason baseline
testing of brain function (neuropsychological assessment) in
athletes.
During season/practice/games
-
Monitor
sports equipment for safety, fit, and maintenance.
-
Enlist
other teachers to monitor any decrease in grades that could indicate
a concussion.
-
Be sure
appropriate staff are available for injury assessment and referrals
for further medical care.
-
Continue
emphasizing with players, staff, and parents your concerns and
expectations about concussion and safe play.
-
Report
concussions that occurred during the school year to appropriate
school staff. This will help in monitoring injured athletes as they
move to the next season’s sports.
Postseason
-
Work with
appropriate staff to review injuries and illnesses that occurred
during the season.
-
Discuss
any need for improvements in your action plan with appropriate
health care professionals and school staff.
-
Discuss
with other staff any needs for better sideline preparations.
Create An Action Plan
To ensure that concussions are managed correctly, have an action plan in
place before the season starts.
-
Identify a
health care professional to manage injuries during practice and
competition.
-
Fill out
the pocket card enclosed in this kit and keep it with you on the
field of play so that information about signs, symptoms, and
emergency contacts is readily available.
-
Be sure
that other appropriate athletic and school staff and health care
professionals know about the plan and have been trained in its use.
When a Concussion Occurs
If you suspect that a player has a concussion, implement your action
plan by taking
the following steps:
-
Remove the
athlete from play. Learn how to recognize the signs and symptoms of
concussion in your players. Athletes who experience signs or
symptoms of concussion should not
be allowed to return to play. When in doubt, keep the player out of
play.
-
Ensure
that the athlete is evaluated
by an appropriate health care professional. Do not try to judge the
severity of the injury yourself. Health care professionals have a
number of different methods that they can use to assess the severity
of concussion.
-
Inform the
athlete’s parents or guardians about the known or possible
concussion and give them the fact sheet on concussion. Make sure
they know that the athlete should be seen by a health care
professional.
-
Allow the
athlete to return to play only with permission from an appropriate
health care professional. Prevent second impact syndrome by delaying
the athlete’s return to the activity until the player receives
appropriate medical evaluation and approval for return to play.
Communicating Effectively
about Concussions
It’s important to raise awareness about sports-related concussion
throughout the school community. To educate athletes, parents,
principals, and other school staff about concussion prevention, look for
opportunities to make presentations to each group.
Athletes. Show them the video and pass out the concussion fact
sheet. Emphasize that you take this issue seriously and that you expect
them to do so as well. Consider devoting a regular team meeting to this
topic and inviting a health care professional to speak to your team. Use
some of the following talking points to guide your discussion with
athletes:
-
“Every
bump, blow, or jolt to the head is a potential concussion.”
-
“Signs and
symptoms of concussion can appear right away or days or weeks after
the injury. Know and look for any signs of a concussion, even if you
think the injury was minor.”
-
“Tell
coaching staff, your parents, or a health care professional if you
receive a bump, blow, or jolt to the head or have signs and symptoms
of concussion.”
-
“Tell your
coach if you received a concussion in another sport.”
-
“You can
get a concussion during drills, practices, and games. Injuries that
happen during practice can be just as serious as those that happen
during competition.”
-
“Do not
play through symptoms of concussion. Your risk of having a second
concussion and serious injury increases at this time.”
-
“It’s
better to miss one game than the whole season.”
Parents.
Send the concussion fact sheet to each athlete’s family during the
preseason, and again if a concussion occurs. You might also hold parent
forums to let them know about your school’s plans for concussion
prevention and management. Consider using some of the following talking
points to guide your discussion with parents:
-
“We know
you care about your teen’s health. That is why it is so important
that you talk to them about the potential dangers of concussion.”
-
“Every
concussion should be taken seriously.”
-
“Know and
watch for any signs and symptoms of concussion if your teen has any
blow to the head. Signs and symptoms can appear right away, or days
or weeks after the injury happens.”
-
“Discourage your teen from playing when experiencing any signs or
symptoms of concussion.”
-
“Alert
your teen’s coach to any known or suspected concussion. This can
help prevent second impact syndrome, which reportedly can happen
when an athlete has more than one concussion over a short period of
time (hours, days, or weeks).”
School
principal and athletic director. Look for opportunities to meet with
your school principal and athletic director. Explain the seriousness of
the issue and the impact that concussion in high school sports can have
on the athlete, the team, and the school. Describe the action plan and
your concussion education efforts and ask for the principal’s support.
Consider using some of these talking points in your discussion with your
principal:
-
“Each year
more than a million high school athletes are involved in contact
sports. Concussions can happen in any sport, including soccer,
football, basketball, field hockey, and wrestling.”
-
“School
staff members, working as a team with health care professionals and
parents, are key to preventing or correctly managing concussions.”
-
“Keeping
students healthy and safe helps protect the reputation of the school
and provides a positive and supportive environment for learning.”
-
“Sometimes
poor grades can be associated with cognitive problems from a
concussion.”
-
“Sometimes
behavior changes in the classroom can be due to an undiagnosed
concussion.”
-
“It’s
ideal to have a health care professional available during athletic
activities—both practice and actual competition.”
-
“Communication should be established among coaches of different
sports so an athlete does not go from one sport to another with a
concussion.”
-
“Coaches
of all relevant sports should be encouraged to distribute
educational materials about concussion to athletes and parents.”
References
1. Powell JW, Barber-Foss KD. Traumatic brain injury in high school
athletes. Journal of the American Medical Association 1999;282:958–963.
2. Harmon KG. Assessment and management of concussion in sports.
American Family Physician 1999 Sep 1;60(3):887–892, 894.
3. Powell JW. Cerebral concussion: causes, effects, and risks in sports.
Journal of Athletic Training 2001;36(3):307–311.
4. Kushner DS. Mild traumatic brain injury. Archives of Internal
Medicine 1998;158:1617–1624.
5. Sosin DM, Sniezek JE, Thurman DJ. Incidence of mild and moderate
brain injury in the United States, 1991. Brain Injury 1996;10:47–54.
6. Guskiewicz KM, Weaver N, Padua DA, Garrett WE. Epidemiology of
concussion in collegiate and high school football players. The American
Journal of Sports Medicine 2000;28(5):643–650.
7. Zemper ED. Two-year prospective study of relative risk of a second
cerebral concussion. American Journal of Physical Medicine and
Rehabilitation 2003 Sep;82:653–659.
8. Institute of Medicine (US). Is soccer bad for children’s heads?
Summary of the IOM Workshop on Neuropsychological Consequences of Head
Impact in Youth Soccer. Washington (DC): National Academy Press; 2002.
9. Centers for Disease Control and Prevention (CDC). Sports-related
recurrent brain injuries—United States. Morbidity and Mortality Weekly
Report 1997;46(10):224–227. Available at:
www.cdc.gov/mmwr/preview/mmwrhtml/00046702.htm
10. Lovell MR, Collins MW, Iverson GL, Johnston KM, Bradley JP. Grade 1
or “ding” concussions in high school athletes. The American Journal of
Sports Medicine 2004;32(1):47–54.
Additional Resources
Centers for Disease Control and Prevention
This website has English and Spanish fact sheets and brochures on
concussion and traumatic brain injury.
www.cdc.gov/ncipc
Brain Injury Association of America
This organization provides information and resources to improve the
quality of life for individuals with brain injuries.
www.biausa.org
CDC does not endorse the articles, products, or guidelines of other
organizations or individuals referenced in these materials. CDC provides
this information to raise awareness about the magnitude of concussion in
high school sports as a public health issue and to offer a scientific
overview of the topic.
Centers for Disease Control and Prevention gratefully acknowledges the
following organizations for their participation in this project:
American Academy of Pediatrics
American Association for Health Education
American College of Sports Medicine
American School Health Association
Association of State and Territorial Health Officials
Brain Injury Association of America
Institute for Preventative Sports Medicine
National Association for Sport and Physical Education
National Athletic Trainers’ Association
National Federation of State High School Associations
National Safety Council
North American Brain Injury Society
University of Pittsburgh Medical Center Sports Medicine Concussion
Program
U.S. Department of Education
|