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Injury Prevention

Concussion Syndrome

Dr Larry W. McDaniel and Matt Ihler discuss present information related to the personal effects of concussions and how concussion syndrome may be prevented.

The purpose of this paper is to inform coaches, athletes, and other individuals about the prevention and care of concussions. This paper will discuss concussion syndrome and the effects of concussions on individuals. Concussions are serious injuries and should not be overlooked under any circumstance. Numerous steps can be taken to help prevent concussions and care for them.

Sports-related concussions are a common injury that can happen to any athlete in any sport. An estimated 300,000 sports-related traumatic brain injuries, primarily concussions, occur annually in the United States (Gessel et al., 2007)[2]. Concussions should be taken seriously and monitored closely. Concussions are the most common type of acute brain injury in sports (Powell 2001)[5].

Post-concussion symptoms when making return-to-play decisions may expose athletes to subsequent injury if complete recovery has not occurred. Athletes, coaches, and athletic trainers must be educated in the processes of preventing and treating concussions. Developing an effective sport-related concussion preventive measure depends upon increasing our knowledge of concussion rates, patterns, and risk factors (Gessel et al., 2007)[2]. Concussions in sports have been increasing over the past several years. As the number of athletes who participate in sports increases, the number of concussions increases. Repetitive concussions and post-concussion syndrome have been responsible for the retirement of many high-profile athletes. The athlete's physical and mental status may be affected by developing a severe brain injury.

The most common symptoms of post-concussion syndrome include a headache, dizziness, blurred vision, neck pain, fatigue, problems sleeping, and problems with balance or coordination. An athlete suffering from a concussion should be monitored for at least 24 hours following the concussion. In addition to monitoring, the athlete should be awakened during sleep every 2 hours (Guskiewicz et al. 2004)[3]. On average, certified athletic trainers care for seven to eight concussions per year. Not only should athletic trainers be able to recognize the obvious signs of a concussion, but they should be aware of the self-reported symptoms as well. Athletic trainers need to be informed that no two concussions are the same and that the symptoms may be different from one concussion to the next.

The primary mechanism of a concussion involves contact with another person (Gessel et al. 2007)[2]. As Harmon (1999)[4] states, there are many potential risks for athletes who return to activity too early. This includes the possibility of permanent neurological impairment from cumulative trauma, post-concussion syndrome, and the most severe of all, death resulting from a second brain impact syndrome. Athletes who suffer from second-impact syndrome remain alert for several seconds before collapsing. After suffering a concussion, the athlete's chances to sustain another concussion increase by four to six times (Harmon 1999)[4].

Concussions are a clinical syndrome characterized by immediate, transient post-traumatic impairment of neural function caused by changes in consciousness, vision disturbance, or equilibrium. The loss of consciousness (LOC) does not correlate directly with the severity or outcome of a concussion (Whiteside 2006)[6]. Concussions represented approximately 8.9% of all high school athletic injuries and 5.8 of collegiate athletic injuries (Gessel et al. 2007)[2]. The rates at which concussions occur are higher among college athletes than high school athletes. College athletes are bigger, stronger, and more aggressive than high school athletes. Also, concussions represent a higher proportion of all injuries sustained by high school athletes. Females were found to have a higher rate of concussions than males (Gessel et al. 2007). Most concussions were reported while playing soccer, lacrosse, and American football (Covassin et al. 2003)[1].

The symptoms most frequently associated with a concussion include headache, dizziness, and confusion. Research of sports-related concussions has provided athletic training and medical professions with valuable new knowledge. The concussion injury rate was 0.23 concussions per 1000. The rates of concussions were higher during the competition than practice rates. The practice rate was 0.11 concussions per 1000, while competition rates rose to 0.53 per 1000 (Gessel et al. 2007)[2].

An athlete who loses consciousness or experiences amnesia over 15 minutes should immediately be referred to a physician for further evaluation. The athletic trainer should take a conservative approach when dealing with an athlete who has suffered a previous concussion (Guskiewicz et al. 2004)[3]. The education and knowledge of coaches, athletes, and parents play a vital role in preventing and treating concussions in the future.

Documenting the information about the specific injury is an important task for the training staff. This process includes the time and date of the injury, state of consciousness, initial signs and symptoms, and findings during testing (Guskiewicz et al. 2004)[3]. The recognition of a sports-related concussion may be challenging. Therefore, numerous concussions are overlooked and not treated. Many athletes may have no apparent signs that indicate they have suffered a concussion.

The signs and symptoms may disappear rapidly or remain present for an extended period. A concussion may cause an immediate and short-lived impairment of neurologic function. Compressive, tensile, and shearing are three types of stresses generated by an applied force that injures brain cells (Guskiewicz et al. 2004)[3]. The athletic trainer needs to assess the cranial nerves, coordination, and motor functioning following a suspected concussion (Harmon 1999)[4]. The athletic trainer should ask the athlete several questions involving orientation versus recent memory when evaluating a concussion. Orientation questions are concerned with time and place.

Sample questions trainers may use for assessing an athlete's memory include; "which field were you playing on", "what is the name of the team we are playing", "which quarter, period, or half is it", "which team scored last", "what team did we play last week", or "did we win". The Balance Error System may be used as a screening tool to determine return-to-play readiness. Athletes are asked to close their eyes and hold their hands at their hips. The trainer will have the injured athlete perform this test on different surfaces. The presence of any stumbling, opening of the eyes, or lifting hands indicated a possible concussion (Whiteside 2006)[6]. The athlete's airway, breathing, and circulations should be a priority for evaluation by the trainer.

Following these procedures, the trainer will determine whether or not the athlete loses consciousness, evaluate recently acquired memory, evaluate the postural stability, and symptoms (Harmon 1999)[4]. An athlete who has sustained a concussion should be evaluated at rest and during exertion. Symptoms may not be present at rest but will return throughout physical exertion.

A scale from one to three will be used to determine the seriousness of the concussion. A grade one concussion will involve transient confusion, no loss of consciousness, a short period of post-traumatic amnesia, and symptoms lasting longer than 15 minutes. A grade two concussion will include loss of consciousness for less than 5 minutes and amnesia that may last 30 minutes. A grade three concussion will involve a loss of consciousness (LOC) for more than 5 minutes and extended amnesia (Covassin et al. 2003)[1]. The trainer will search for any indications of dizziness, headache, and inability to concentrate. The athletic trainer should not allow the athlete to return to play in any circumstances while symptoms are present. Current guidelines suggest that athletes who experience loss of consciousness (LOC) should not return to play on the day of the injury (Whiteside 2006)[6]. The length and duration of the symptoms, along with LOC will be significant when determining the severity of the concussion. According to Harmon, more than 90% of all concussions are mild, and less than 10% result in the athlete losing consciousness (Harmon 1999)[4].


  1. COVASSIN, T. et al. (2003) Sex Differences and The Incidence of Concussions Among Collegiate Athletes. Journal of Athletic Training, 38 (3), p.238–244
  2. GESSEL, L. M. et al. (2007) Concussions among United States High School and Collegiate Athletes. Journal of Athletic Training, 42 (4), p. 495–503
  3. GUSKIEWICZ, K. M. et al. (2004) National Athletic Trainers Association Position Statement: Management of Sports Related Concussion. Journal of Athletic Training, 39 (3), p. 280–297
  4. HARMON, K. G. (1999) Assessment and Management of Concussion in Sports. American Family Physician, 60 (3), p. 887-892, 894
  5. POWELL, J. W. (2001) Cerebral Concussion: Causes, Effects, and Risks in Sports. Journal of Athletic Training, 36(3), p. 307–311
  6. WHITESIDE, J. W. (2006) Management of Head and Neck Injuries by the Sideline Physician. American Family Physician, 74 (8), p. 1357-1364

Page Reference

If you quote information from this page in your work, then the reference for this page is:

  • McDANIEL, L. and IHLER, M. (2008) Concussion Syndrome [WWW] Available from: [Accessed

About the Authors

Dr Larry McDaniel is an associate professor and advisor for the Exercise Science program at Dakota State University, Madison SD USA. He is a former All-American in football and Hall of Fame athlete & coach.

Matt Ihler is a student enrolled in Exercise Science at Dakota State University.