Concussions are a common reality in sports, with an estimated 3.8 million occurring annually in the United States from sports-related injuries. The Centers for Disease Control (CDC) reports that 5-10% of athletes will experience a concussion in any given season. While men’s football leads in concussion rates, these injuries can happen in any sport, at any time. As an athletic director, your role extends beyond organizing schedules and managing budgets—you are vital to ensuring the safety and well-being of student-athletes. With concussions remaining a prevalent concern, staying informed about updated protocols and prevention strategies is essential for minimizing risks and supporting athletes throughout their recovery.
Common Concussion Myths
Despite the prevalence of concussions in the athletics community, there are still many misconceptions about them.
Myth #1: You can “power-through” a concussion
- The brain consumes more energy during recovery for everyday activities like movement and thinking.
- Pushing the brain and body too hard during recovery can extend recovery time, increase the severity of symptoms and heighten the risk of reinjury.
Myth #2: Concussions always lead to loss of consciousness
- Most people with concussions remain conscious; losing consciousness is not required for a diagnosis.
- If loss of consciousness occurs, it may indicate a more severe injury but is not typical of most concussions.
Myth #3: You need brain imaging to diagnose a concussion
- Concussions are diagnosed based on symptoms, which vary between individuals, rather than through brain imaging.
- Imaging tests often do not reveal concussions since they affect nerve function rather than creating visible bruises or abnormalities.
Myth #4: You shouldn’t let someone with a concussion sleep
- Sleep is essential for recovery and promotes healing.
- Light physical activity, like walking, can support recovery, provided it doesn’t worsen symptoms.
- Concussed individuals can safely perform daily activities except for heavy exercise and sports, as long as symptoms are monitored.
Myth #5: You don’t have a concussion if you don’t immediately experience symptoms
- Concussion symptoms can take hours, days or even a week to appear. A concussion diagnosis should not be ruled out just because symptoms don’t appear immediately.
- Early concussion symptoms may include confusion, headache, dizziness or memory loss. Delayed concussion symptoms include sensitivity to light and noise, irritability, difficulty sleeping, fatigue or depression.
These myths emphasize the need for accurate education about concussions and prompt consultation with healthcare providers for proper management.
Revised Concussion Protocol
For the first time since 2014, the National Athletic Trainers Association (NATA) released new concussion protocols in March 2024. The 2024 NATA Bridge Statement updated concussion management protocols by emphasizing a biopsychological approach, integrating physical, mental and social factors in patient care. One of the key changes made updates the rest recommendations post-concussion. Past research encouraged total rest until concussion symptoms resolved, but new research suggests that encouraging early aerobic activity (within 1-2 days) to speed recovery, reducing reliance on strict rest and incorporating vision and vestibular assessments, can aid recovery. Mental health evaluations are now essential, as preexisting conditions like anxiety or ADHD can impact recovery. Baseline testing is optional unless required by institutions, with a shift towards clinical judgment over computerized tests. Athletic trainers are urged to collaborate with school-based teams for academic accommodations and tailor return-to-play and return-to-learn strategies to individual athletes. Documentation remains critical, while early care and individualized rehabilitation are emphasized to improve outcomes and reduce prolonged symptoms.
Concussions and Mental Health
As shown in NATA’s updated concussion guidelines, mental health screening is a significant factor in concussion treatment. Both preexisting and post-injury mental health issues can impact recovery outcomes. Athletes with prior mental health conditions, such as anxiety or depression, often reported heightened symptoms at baseline, complicating concussion assessments and prolonging recovery. Additionally, concussions can exacerbate existing mental health concerns or trigger new mood disturbances, including anxiety, depression and post-traumatic stress. Studies show that untreated mental health issues can delay athletes’ return to play and impair their overall well-being.
Effective management urges for a proactive, individualized approach, including mental health screenings, psychoeducation and collaboration with specialized mental health professionals. Timely intervention and continuous mental health support are essential, as unresolved psychological symptoms are one of the leading contributors to persistent post-concussion symptoms (PSaSRC). Integrating mental health care into concussion protocols can aid in a smoother recovery and enhance athletes’ readiness to return to their sport and daily activities.
Concussion Prevention
There are many layers to preventing concussions, as no single intervention has proven fully effective.
- Proper Equipment: In contact sports like football and hockey, helmets and protective equipment reduce the risk of severe head injuries, but they aren’t concussion-proof. Proper helmet fit and sport-specific use are essential, as poorly fitted helmets increase symptom severity. Using additional protective gear, such as Guardian Caps or mouthguards, can also help prevent concussion.
- Diet and Nutrition: Diet and nutrition can help prevent concussion and aid recovery. Nutritional supplements, such as creatine, curcumin and DHA, show promise in mitigating neurological damage from concussive and sub-concussive impacts, although more human studies are needed to confirm these effects. Having a healthy diet is incredibly important for recovery, as the brain and body start off with more appropriate levels of the nutrients they need.
- Behavior-based strategies: Behavior-based strategies also play a critical role, including teaching proper tackling techniques, strengthening neck muscles and avoiding head-first contact.
- Rule changes: Rule changes such as limiting contact during practices and banning certain aggressive moves have effectively reduced concussion risk in some sports.
While concussions cannot be fully prevented, a combination of equipment, behavioral strategies and policy changes offers the best chance to minimize risk. It’s imperative to educate athletes and staff about concussion prevention in order to reduce long-term risks.
Concussions remain a significant challenge in sports–highlighting the need for ADs and all athletic staff to stay up-to-date on prevention, management and recovery. By debunking myths, following evidence-based protocols, promoting mental health support and implementing behavior-based prevention strategies, athletic programs can create safer environments for athletes. While concussions cannot be entirely prevented, a combination of proper equipment, education and policy changes offers the best path forward. Athletic directors play a pivotal role in this process, ensuring athletes receive the care they need to recover fully and safely return to play.
