By Dev K. Mishra, M.D.
President, Sideline Sports Doc
Clinical Assistant Professor of Orthopedic Surgery, Stanford University
- A recently published article in the American Journal of Sports Medicine showed that a large number of college athletes indicated that they had not reported prior concussions to trainers or coaches
- Reasons for non-reporting essentially fell into two categories: player did not want to be removed from competition, or the player did not think that their injury was a concussion
- Men were more likely to resist disclosing a concussion than women
- The study points to the need for continuing education of players and coaches about the need to recognize and disclose a possible concussion
- My suspicion is that similar trends occur in the younger age groups. Peer pressure and desire to continue playing are powerful forces.
We’ve known for as long as people have played sports that athletes will either not disclose an injury, or that they would play through an injury. For some injuries this probably isn’t a big deal, but for other injuries continued play would be a real risk for making the injury worse or possibly having a second injury resulting in permanent damage. For concussions, repeated injury can be disastrous. So it’s in our best interest as parents, coaches, and players to do everything we can to encourage players to disclose possible concussions and stop hiding from them.
This study is interesting as it looks at reasons for not disclosing concussions, and it attempts to get an estimate of how often athletes do not disclose possible concussions. It is a retrospective (meaning backward-looking) study of former collegiate athletes at a major D1 university, so its direct application to youth sports might be limited. Still, I know with certainty that young athletes will also try to hide from concussions so there are points we can take away from this study.
About one-third of the surveyed athletes indicated that they had not reported at least one concussion during their collegiate playing career. Two-thirds of the football players indicated that they had not disclosed at least one possible concussion. On the women’s side 85% indicated that they had disclosed all possible concussions, although interestingly in women’s soccer the full disclosure happened only 58% of the time (this university is a perennial nationally ranked powerhouse in women’s soccer).
The motivations for non-reporting are not surprising. The most commonly reported motivations included the following: did not want to leave the game/ practice (78.9%), did not want to let the team down (71.8%), did not know it was a concussion (70.4%), and did not think it was serious enough (70.4%).
In collegiate sports, the pressure to continue playing can be powerful. Some athletes could be in line for professional sports careers, many athletes could feel pressure from teammates, coaches, and fans. These athletes will want to stay in competition, a factor that sometimes will override their knowledge of concussion as a serious injury. As clinicians or parents we need to acknowledge these forces and work with athletes to reduce fears surrounding concussion disclosure.
For the younger athletes, psychological motivations can be equally powerful although they may be dictated more from peer pressure than other sources. What we can do is be their eyes and ears. Coaches are incredibly influential in this area. A coach properly trained in concussion recognition can be a huge help in reducing the chances for another concussion, and the coach can model effective behavior that’s in the best interest of the athlete. Parents and teammates are other major influences for young athletes. Let’s all be smarter about concussions and help the young athlete to do the right thing.