High school and college athletes in the United States are in the grip of a silent pandemic. According to the University of Pittsburgh Medical Center’s Concussion Center (UPMC), between 1.7 and 3 million sports and recreation-related concussions happen annually in the United States . To put this number into perspective, it is estimated by UPMC that two in every ten high school athletes who play contact sports will suffer a concussion (mild traumatic brain injury) this year. While the sheer number of young athletes that suffer head injuries is quite sobering, it may not be the most insidious aspect of this silent pandemic. The vast underreporting of sports-related concussions and the impact that undertreatment has on neurological health may lead to incredible disease burden, the overall impact of the — the extent and magnitude of which is difficult to appreciate.
According to Mark S. Greenberg’s Handbook of Neurosurgery and the American Medical Society for Sports Medicine, concussions are “a traumatically induced transient disturbance of brain function that involves a complex pathophysiological process” .
Essentially, a concussion is the alteration of normal brain function that is created by nonpenetrating mechanical forces, such as falls, rapid changes in direction, impacts, etc. Greenberg’s Handbook of Neurosurgery notes that the true pathophysiology of concussion is poorly understood. Some symptoms of concussion begin rapidly and resolve within a few days. However, other symptoms, especially after multiple injuries, may persist for months, years, or a lifetime . These long-term effects include “deficits in balance, coordination, memory/cognition, strength, or alertness” . Concussions are extremely serious injuries. The symptoms, both short and longterm, can seriously impact a child or young adult’s normal development.
While it may seem intuitive for coaches and athletes alike to report any head injuries or symptoms for further medical evaluation, the polar opposite ensues in reality. Coaches and athletes (especially those in football and ice hockey) do not self-report symptoms associated with head trauma. In McCrea et al.’s 2004 study of 1,532 football players, only 47.3% of athletes reported their concussion symptoms . When asked why they did not report their symptoms to appropriate personnel, the players had three main responses: they did not feel as though the injury was serious enough to warrant medical attention, they did not want to be withheld from competition, or they did not understand the risks and symptoms of possible concussion. Furthermore, work by Dr. William P. Meehan and Dr. Rebekah C. Mannix, top concussion experts at Boston Children’s Hospital, revealed that nearly one third of athletes seen in the clinic had previously undiagnosed and unreported concussions .
The effects of underreporting can be disastrous. As Drs. Meehan and Mannix note, “failure to diagnose concussions in athletes can lead to further insults to the brain prior to full recovery, exposing these athletes to the cumulative effects of injuries and an increased risk of second impact syndrome” . The effects of multiple head injuries in a short period of time is clearly documented in Iverson et al.’s 2003 study: “cumulative effects of concussion in amateur athletes.” At the conclusion of the study, the authors had two primary findings: 1) athletes with multiple concussions reported more symptoms than athletes with no history of concussion, and 2) athletes with multiple concussions scored significantly lower on memory testing than athletes with a single concussion two days post-injury . The impact of repeated head injuries is therefore significant on the young brain. High school and college athletes, who should have no major neurological deficit at their age, are suffering from cognitive, behavioral, and emotional issues as a result of repeated blows to the head.
“The silent epidemic,” as coined by the Brain Injury Association of America, is a dire public health issue — not only because of the sheer number of injuries but also because of the significant neurological consequences of underreporting. Countless lives have been changed forever due to head injury, and now is the time to develop policy to stop this tragic trend. How is it done?
Top brain injury experts are in agreement that the solution is not to stop young athletes from competing in amateur sports . Children should not be encouraged to stop playing football or hockey if it is what they love to do; rather, the key is creating a way to keep athletes in the game safely. The critical facet for further concussion prevention is education.
Comprehensive education plans for coaches, parents, and athletes must be implemented at all levels of sports. One solution may be a mandated training program for all participants prior to beginning practice or competing each season. Extensive work by Dr. Charles H. Tator at the University of Toronto has shown that various methods of information dissemination, including mandatory education meetings, have been shown to increase concussion awareness and, as a result, reporting of symptoms .
By demonstrating to athletes and coaches alike that it is acceptable to speak up when injured, adequate and timely treatment can occur that minimizes risk for further head injury. Too many lives have been drastically changed, and it is imperative we ensure that our next generation of young athletes does not find themselves in poor neurological health due to repeated head injuries. We can create an environment where head injuries are given the importance they deserve. Together, we can begin to fix the broken minds of America’s young athletes.
1. Concussion Statistics and Facts: UPMC: Pittsburgh. UPMC Sports Medicine. (n.d.). Retrieved March 14, 2022, from https://www.upmc.com/services/sportsmedicine/services/concussion/about/facts-statistics
2. Greenberg, M. S. (2020). Handbook of Neurosurgery. Thieme Medical Publishers.
3. Harmon, K. G., Clugston, J. R., Dec, K., Hainline, B., Herring, S., Kane, S. F., Kontos, A. P., Leddy, J. J., McCrea, M., Poddar, S. K., Putukian, M., Wilson, J. C., & Roberts, W. O. (2019). American Medical Society for Sports Medicine Position Statement on Concussion in sport. Clinical Journal of Sport Medicine, 29(2), 87–100. https://doi.org/10.1097/jsm.0000000000000720
4. Iverson, G. L., Gaetz, M., Lovell, M. R., & Collins, M. W. (2004). Cumulative Effects of Concussion in Amateur Athletes. Brain Injury, 18(5), 433–443. https://doi.org/10.1080/02699050310001617352
5. Mannix, R., Meehan, W. P., & Pascual-Leone, A. (2016). Sports-related concussions — media, science and policy. Nature Reviews Neurology, 12(8), 486–490. https://doi.org/10.1038/nrneurol.2016.99
6. McCrea, M., Hammeke, T., Olsen, G., Leo, P., & Guskiewicz, K. (2004). Unreported Concussion in High School Football Players. Clinical Journal of Sport Medicine, 14(1), 13–17. https://doi.org/10.1097/00042752-200401000- 00003
7. Meehan, W. P., Mannix, R. C., O'Brien, M. J., & Collins, M. W. (2013). The Prevalence of Undiagnosed Concussions in Athletes. Clinical Journal of Sport Medicine, 23(5), 339–342. https://doi.org/10.1097/jsm.0b013e318291d3b3
8. Tator, C. H. (2012). Sport Concussion Education and Prevention. Journal of Clinical Sport Psychology, 6(3), 293–301. https://doi.org/10.1123/jcsp.6.3.293