The Concussion Return to Play Guide for High School Athletes

Concussions rates by sport among United States high school athletes

A study by the Center for Injury Research and Policy recently examined concussions suffered by high school athletes in the United States in 20 sports during the 2008 to 2010 school years. During that time, an estimated 300,000 sports-related concussions happened each year. The only activity, the report said, that causes more concussions among high school students is motor vehicle accidents.

Concussion Rates by Sport

The study found the following sports concussion statistics:

• • The injury rate was six times higher for competition and games than for practice.

• • The highest concussion totals per sport were as follows (from high to low):

    • • 47.1%
    • • Girls’ soccer. 8.2%
    • • Boys’ wrestling. 5.8%
    • • Girls’ basketball. 5.5%

• • 6.4%

• • Boys’ ice hockey 5.4%

• • Boys’ lacrosse 4.0%

• • Common reasons for concussions were mostly player-to-player contact, followed by player-to-surface contact.

• • Over half of the athletes returned to play in one to three weeks. Only 2% returned the same day.

Understanding the type of sport played, the type of contact, the gender of the players, and the risk factors involved can help implement safety and prevention measures aimed at reducing the risk of high school concussion injuries.

What are the symptoms of mild traumatic brain injury?

A concussion is a form of traumatic brain injury (TBI). A concussion is considered minor if the athlete loses consciousness or any confusion lasts less than 30 minutes. Even though diagnostic tests may be standard, the athlete may suffer physical, cognitive, or emotional problems. A mild TBI can do more than render the athlete unable to return to play. It directly affects the well-being of the player and those who live with the athlete.

According to Traumaticbraininjury.com:

• • Concussions are also called minor head trauma, minor brain injury, minor head injury, or minor TBI.

• • A mild TBI is often not properly diagnosed at the time of the injury.

• • Even though the word mild is used, the injury can be quite serious. About 15% of people with a mild TBI diagnosis have symptoms that last for more than 12 months.

Symptoms after the injury are called “post-concussive syndrome.” Many of the physical, cognitive, emotional, and daily living symptoms have been described above (see the concussion symptom section). Additional symptoms can include loss of smell, changes in mood, light sensitivity, and audio sensitivity.

Symptoms can often be missed, in part, because they may not appear until days or even weeks after the initial trauma. It is important for family and friends to monitor the athlete. Family and friends are much more likely to notice the symptoms than the child athlete.

What are the symptoms of severe traumatic brain injury?

Athletes who suffer a severe traumatic brain injury often die or suffer permanent disability. According to the CDC, TBIs are a factor in almost a third of US injury-related deaths. Many other serious TBIs require the patient to be hospitalized.  A severe TBI impacts more than just the victim. The family suffers as well.

Doctors, family, and coaches should understand how a TBI is classified. A common clinical tool is the Glasgow Coma Scale, which analyzes whether the patient is in a coma or is experiencing impaired consciousness.

The scale is:

• • Severe TBI. 3 to 8

• • Moderate TBI. 9 to 12

• • Mild TBI. 13 to 15

Other scales used to review a TBI are:

• • Abbreviated Injury Scale (AIS)

• • Trauma Score

• • Abbreviated Trauma Score

About 43% of patients with a severe TBI have a disability one year after the injury. Over five million Americans live with some TBI-related disability that limits their ability to function.

Sports injury case studies and their impact on your child

Several studies have been conducted on the effects of sports injuries. One prominent study at the Florida Center for Headache and Sports Neurology scanned the brains of 40 former National Football League (NFL) players who had recently retired from the game. The study found that 43% of these players averaged age 36 and had more white brain matter damage than healthy 36-year-olds. White matter is a vital brain factor for learning. White matter damage, another way of saying traumatic brain injury, can lead to chronic traumatic encephalopathy, Alzheimer’s, and other brain conditions.

The study did not find a direct link between the number of concussions a player suffered and the amount of white matter damage. There did appear to be a link between the number of physical hits and white matter damage. The NFL is now determining the right balance between protective research and recommended treatments, the safety of current and future NFL players, and the cost of settling legal claims by prior NFL players.

The NFL research may, in time, help high-school and college athletes. Still, more studies need to be done to determine the dangers to children and the best community and medical course of action in the treatment and prevention of TBI and other sports-related injuries among children.