Some of my most memorable experiences during middle school and high school came from my time on sports teams. I made rich, lasting friendships with my cross country and track teammates and developed a love for fitness that continues today. For other student-athletes, however, their participation in sports teams can have a different, more serious, lasting impact: traumatic brain injury (TBI).
Traumatic brain injury is caused by trauma to the head that disrupts normal function of the brain. A mild TBI, also called a concussion, involves only a brief change in mental state. A severe TBI consists of an extended period of unconsciousness after an injury.1 Long term effects of TBI include cognitive, emotional, and behavioral changes.2 In 2014, 837,000 children were taken to the emergency department or hospitalized with a TBI; 2,529 resulted in death.1 However, the true rate of concussions in children is known to be even higher, because many are treated outside of the emergency room or hospital or are not treated at all.
High school athletes are particularly vulnerable to TBI. The 2017 Youth Risk Behavior Survey found that 15.1% of all students surveyed had experienced at least one concussion that occurred while playing sports, and 6.0% reported having two or more.3 One study found that, among 800 high school athletes, 69% reported playing with concussion symptoms, and 40% of those athletes said their coach was not aware they had a possible concussion.4 An athlete might not tell their coach or parent about a possible concussion because of a fear of losing their position on the team or play time during a game, jeopardizing a future sports career, and letting their team down.5 Athletes may be even less likely to report a concussion during a championship game or other important competition.6
Be familiar with the signs and symptoms of TBI. Athletes may report the following7:
- Nausea or vomiting
- Dizziness, visual changes
- Sensitivity to light or noise
- Feeling sluggish or foggy
- Confusion, memory problems, or trouble focusing
Coaches or parents may observe the following in an athlete with TBI7:
- Loss of consciousness
- Appears confused or forgetful
- Unable to follow instructions
- Moves clumsily
- Unable to recall events leading up to
- Mood, behavior, or personality changes
If you are concerned about a possible TBI in an athlete, the safest course of action is to immediately remove them from play until they are evaluated and cleared by a healthcare provider.7
There are important steps that team leadership can take to minimize the risk of TBI among their players. First, coaches and administrators should ensure all equipment is up to date and safe for play. This includes properly fitting helmets designed for the impact of that particular sport, padded goalposts, and removal of tripping hazards. Teams should also work to create a culture of sportsmanship and safety by reinforcing the dangers of illegal contact or tackles. And because concussions can occur even with proper use of helmets, safety rules should be enforced to prevent or minimize hits to the head. Finally, it is important to emphasize to athletes the importance of reporting head injuries their coaches or parents and discuss their concerns about reporting.7
School sports can play an enormously positive role in the lives of many students. They instill healthy habits, foster friendships, build confidence, and teach responsibility. However, the effects of TBI can impact students long after they step off the field. Talk to your child about concussions, and ensure that their coaches have been trained to identify concussions in their players. When it comes to student-athletes, safety has to be everyone’s first priority.
1. TBI: Get the Facts. Traumatic Brain Injury and Concussion. Centers for Disease Control and Prevention. March 11, 2019.
2. Institute of Medicine and National Research Council. Sports-related concussions in youth: improving the science, changing the culture. Washington, DC: National Academies Press; 2014.
3. DePadilla L, Miller GF, Jones SE, Peterson AB, Breidling MJ. Self-Reported Concussions from Playing a Sport or Being Physically Active Among High School Students – United States, 2017. MMWR 2018;67:682-685.
4. Rivara FP, Schiff MA, Chrisman SP, Chung SK, Ellenbogen RG, Herring SA. (2014). The effect of coach education on reporting of concussions among high school athletes after passage of a concussion law. Amer J Sports Med, May, 2014, 42(5):1197-1203.
5. Kerr ZY, Register-Mihalik JK, Marshall SW, Evenson KR, Mihalik JP, Guskiewicz KM (2014). Disclosure and non-disclosure of concussion and concussion symptoms in athletes: Review and application of the socio-ecological framework. Brain Inj. 2014;28(8):1009-21.