Concussions: What Do We Know?

The Challenges of Protecting Athletes

by Leslie Duinink and Dawn Reece

Talk of concussions and their consequences has become a staple in American media and culture. Whether it is the suicide of a famous former NFL star or a soccer league that bans headers, the importance of preventing concussions has taken center stage. So, how did we get to this level of concern, and why is it difficult to protect athletes?

Little Bump, Big Problem

A concussion is a type of traumatic brain injury. Concussions are caused by a bump or blow to the head or body that can impair physical abilities and how a person thinks, acts and learns. Even a “ding,” “getting your bell rung,” or what seems to be a mild blow can be serious. It may or may not include loss of consciousness — most concussions occur without a loss of consciousness. Children and adolescents are more susceptible to concussions and take longer to recover from their symptoms than adults. (CDC)

Concussions are widespread. “Sports and recreation-related concussions are serious injuries, with an estimated 325,000 children and teens treated in emergency departments for sports and recreation-related traumatic brain injury (TBI) in 2012” (Baldwin et al., 2016). That doesn’t begin to include the number seen in doctor’s offices or athletic training rooms — if they are seen by medical professionals at all.

While 80 to 90 percent of concussions resolve successfully if managed well in the first three weeks, symptoms can persist in some cases (Collins, 2006). Symptoms can impact the individual at home, school and work. Some symptoms experienced include changes in thinking, emotions, and sleep patterns. Prolonged symptoms that are not accommodated for can result in increased mental health symptoms such as depression or anxiety. Nationally recognized return-to-learn and return-to-play protocols provide post-concussion strategies to support an individual’s recovery and can be adapted to the needs of each person. Time and patience are key, as each concussion and recovery from concussion is unique.

Is This a Concussion?

Researchers in medicine and exercise science have now turned their attention to education and reporting of concussions. After all, how can you solve a problem if you can’t name it? Studies to assess what athletes and coaches know about symptoms of a concussion have been conducted across multiple sports, sport levels and constituencies.

What do these different groups know about concussions? The unsatisfying answer is that it varies greatly. It varies by the group being studied and by symptom. Coaches know more than the general public, but still less then they need to know. In studies of high school football coaches, subjects were able to identify confusion, headache and disorientation as signs of concussion (McLeod, 2007, Guilmette, Malia, McQuiggan, 2007). However, they were less able to identify vision problems and nausea. Work remains to assist coaches, parents and players in identifying symptoms of concussions.

Independent of an individual’s knowledge of concussion symptoms, in a review of 31 recent publications on concussions, Kerr (2016) cites that only between 7 and 23 percent of concussed individuals across these studies were able to recognize they had a concussion. What this means is, regardless if the individual knows what concussion symptoms are, when athletes experience a blow to the head they may not correctly identify what they have experienced as a concussion. This makes education of coaches, teammates and parents vital.

Additionally, non-reporting by athletes remains an issue. Rivara (2014), in a recent study of 800 high school athletes found that 69 percent admitted to playing with concussive symptoms! This is where social and cultural variables come into play.

I Am Not a Wimp

There are a host of relationships and interpersonal variables that are relevant and active in any instance of concussion during sports. Some of the forces that could be at work include: the athlete’s relationship to coaches and teammates, the type of game they are playing (i.e. practice, regular season or playoff/finals), the gender of the athlete, the culture of the sport, and the informal norms and values of the team. These are all important factors in how an athlete responds to a concussion and his or her willingness to disclose the injury.

Repeatedly, socio-cultural and socio-psychological factors show up in lists of reasons why concussed athletes do not report this experience (Rivara, et al 2014, Bramley, 2012, Provvidenza, 2009). A student’s socialized beliefs tell them injury and pain are an accepted part of playing sports — so playing though pain is normalized. Players also fear losing their hard-earned position on the team. They do not want to be withheld from competition due to expectations from self, teammates, coaches, and parents. This creates and reinforces a “play through it” culture where athletes risk long-term health consequences for short-term gain.

If your identity is largely rooted in your status as an athlete, it shouldn’t be surprising that not playing becomes a threat to an athlete’s core idea of self. White, Young and McTeer (1995) interviewed male athletes and concluded, “Sports participation was so key for our subjects’ identities they often voluntarily chose to play while severely injured” (167). The dominant role of athlete in a person’s sense of self is captured by researchers who report nearly universally that athletes become embarrassed, frustrated, and impatient when withheld from competition (Roderrick, Waddinton & Parker 2000, Liston et al. 2006).

In an interesting sociological study, Nixon (1994) documented what he labels ‘sportsnets,’ which means all the members in an athlete’s social network are somehow linked back to the sport. These ‘sportsnets’ basically produce a barrier for the athlete, preventing him or her from receiving outside, unbiased information.

Changing the Game

By combining the research from the fields of medicine, exercise science and sociology, we can more fully understand an athlete’s attitude and behavior toward concussions. If society’s long-term goals are to reduce concussions as well as to support the individual during recovery, there is a need to improve concussion education, concussion management and the culture around reporting of sports injuries.

Leslie Duinink is associate professor of exercise science at Central College. Dawn Reece is associate professor of sociology. Together, they conduct research related to concussions.

At Central College, curiosity is encouraged and exploration expected. This post is intended to stimulate vigorous, open inquiry, and opinions expressed belong to the author.


Baldwin, G., Breiding, M., Sleet, D. (2016). Using the public health model to address unintentional injuries and TBI: A perspective from the Centers for Disease Control and Prevention (CDC). NeuroRehabilitation 39: 345–349.

Bramley, H. (2012). High school soccer players with concussion education are more likely to notify their coach of a suspected concussion. Clinical Pediatrics 51: 332–336.

TBI: Get the Facts. (n.d.) Retrived January 6, 2017 from CDC website, get_the_facts.html.

Collins, M., Lovell, M. R., Iverson, G. L., Ide, T., & Maroon, J. (2006). Examining concussion rates and return to play in high school football players wearing newer helmet technology: a three-year prospective cohort study. Neurosurgery, 58(2), 275–286.

Guilmette, T., Malia, and McQuiggan, M. (2007). Concussion understanding and management among New England high school football coaches. Brain Injury 21:1039–1047.

Kerr, Z.Y. et al. (2014). Disclosure and non-disclosure of concussion and concussion symptoms in athletes: Review and application of the socio-ecological framework. Brain Injury 28: 1009–1021.

Liston, K. Reacher, D. Smith, A. and Waddington, I. (2006). Managing pain and injury in non-elite rugby union and rugby league: A case study of players at a British university. Sport in Society. 9: 388–402.

McLeod, T.C., Schwartz, C. and Bay, C. (2007). Sports-related concussion misunderstandings among youth coaches. Clinical Journal of Sports Medicine. 17: 140–142.

Nixon, H.L. (1994). Social pressure, social support, and help seeking for pain and injuries in college sports networks. Journal of Sport and Social Issues 18: 340–355.

Provvidenza, C. and Johnston K. (2009). Knowledge transfer principles in sports concussion education. British Journal of Sports Medicine. 43: 68–75.

Rivara, F. et al. (2014). The effect of coach education on reporting of concussions among high school athletes after passage of a concussion law. The American Journal of Sports Medicine. 42: 1197–1203.

Roderrick, M. & Waddington, I. (2000). Paying Hurt: Managing injuring in English professional football. International Review for the Sociology of Sport. 35: 165–180.

White, Young & McTeer. (1995). Sports, masculinity and the injured body. Men’s Health and Illness: Gender, Power and the Body. Thousand Oaks, CA: Sage Publishing.

For more information, see:

REAP the Benefits of Good Concussion Management Authored by Karen McAvoy, PsyD and customized for Iowa by the Brain Injury Alliance of Iowa and the Iowa Concussion Consortium

Concussion at Play: Opportunities to Reshape the Culture Around Concussion

CDC report to congress — 2015