DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR DISEASE CONTROL AND PREVENTION
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mThe Facts 1
mCommunicating Effectively
about Concussions
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mSigns and Symptoms 4
mWhen a Concussion Occurs 11
mPrevention and Preparation 5
1
• 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.
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CONCUSSION: The Facts
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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
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.
Baseball
Basketball
Field Hockey
Football
Gymnastics
Ice Hockey
Lacrosse
Soccer
Softball
Volleyball
Wrestling
3
CONCUSSION: The Facts
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
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
Appears dazed or stunned
Is confused about assignment
Forgets plays
Is unsure of game, score, or opponent
Moves clumsily
Answers questions slowly
Loses consciousness
Shows behavior or personality changes
Can’t recall events prior to hit
Can’t recall events after hit
SYMPTOMS REPORTED BY ATHLETE
Headache
Nausea
Balance problems or dizziness
Double or fuzzy vision
Sensitivity to light or noise
Feeling sluggish
Feeling foggy or groggy
Concentration or memory problems
Confusion
4
Signs and Symptoms
Adapted from Lovell et al. 2004.
5
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.
CONCUSSION: Prevention and Preparation
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.
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CONCUSSION: Prevention and Preparation
7
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
page
its use
10.)
.
(See
“
Create an Action Plan,
”
• 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.
8
CONCUSSION: Prevention and Preparation
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.
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To ensure that concussions are managed correctly, have
an action plan in place before the season starts.
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When a Concussion Occurs
1. 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.
2. 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.
3. 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.
4. 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.
If you suspect that a player has a concussion,
implement your action plan by taking
the following steps:
12
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.
”
Communicating Effectively
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.
about Concussions
CONCUSSION: Communicating Effectively
13
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.
”
CONCUSSION: Communicating Effectively
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CONCUSSION: Communicating Effectively
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• “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.
”
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.
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References
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
February 2005
