Sports and Concussions: What Are the Recommendations?

Take players with suspected concussions out of the game

When it comes to making recommendations, doctors' organizations tend to come late to the game, calling press conferences to state the obvious. The American Academy of Neurology states that "any athlete who is suspected to have suffered a concussion should be removed from participation until he or she is evaluated by a physician with training in the evaluation and management of sports concussions." The Academy's position also includes an educational component to increase concussion education for parents, athletes, and coaches; and reminds us that players should not return to competition until they had recovered from their injury.

It took a little while for common sense to return to the halls of neurology academia; their last position paper from 1997 allowed players with concussions to return to play immediately if they were deemed to be asymptomatic with normal neurologic assessment at rest and with exercise. It was routine to see players running on the sideline after a head injury, as part of their evaluation to determine if concussion symptoms could be provoked.

When head injury is the goal of the sport, concussion prevetion is difficult

While unintentional head injuries occur in sports and daily life, there are sports in which the head is a target, and winning happens when a concussion occurs and the player is knocked unconscious. The Academy has a 2008 position paper on sports that promotes intentional trauma to the brain. One would think that it would be to demand a ban. Instead, while concluding that sports like boxing and mixed martial arts are a serious threat to brain function and even with protective gear can cause "measurable and persistent damage to the brain," the recommendations are muted: Try to decrease the number of blows to the head, educate potential participants about the damage, and work on prevention, especially for kids younger than 16 years of age.

Concussions and violent hits to the head in the NFL made league officials take action and tell players to lower their targets away from the head and neck. Add an instructional video and tens of thousands of dollars in fines, and player behavior changed almost immediately. Rules mandated that players with concussions be removed from the game and not be allowed to return to practice or play until cleared to do so by a qualified physician.

Neurologists: Atheltic trainers should be present at sporting events where kids risk concussion

The neurologists seemed to agree, and tried to adapt this solution to the masses. They failed by recommending an impossible solution: "A certified athletic trainer should be present at all sporting events, including practices, where athletes are at risk for concussion." There are neither enough trainers, nor enough money to pay for those trainers at pee wee football practice, bantam hockey, gymnastics, and the host of sports that make kids happy and get them to be active mentally and physically.

Instead, let us consider a reasonable alternative. Let's teach parents and coaches how to recognize the signs and symptoms of concussion. The education can begin with a few words during routine yearly exams as the kids grow up. Let family doctors and pediatricians spend a few minutes talking about concussion and head injury. Make that education part of the sports physical examination. Kids are smart enough to look out for their teammates if they're given the opportunity and responsibility. And let's make concussion education part of the certifying requirements for coaches.

Concussions are an unfortunate consequence and complication of many sports. Minimizing the risk of brain injury demands that athletes try to play in control, avoid head contact, and wear safe head gear. Even with all the prevention in the world, accidents will happen. Kids will trip. Adults will fall off bicycles and people will run into each other. When that accident occurs, we have to be our brother's keeper and know what to look for, when to send a player to the sideline, and when to get them to a doctor.

The neurologists should promote a simple message that only takes a few moments to learn: Friends don't let friends play with hurt brains.

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Medically reviewed by Joseph Carcione, DO; American Board of Psychiatry and Neurology


Marar, Mallika, et al. "Epidemiology of concussions among United States high school athletes in 20 sports." The American Journal of Sports Medicine 40.4 (2012): 747-755.

McRory P, etal. Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012 Br J Sports Med 2013;47:250-258 doi:10.1136/bjsports-2013-092313.