• Last fall, five high school football players died as a result of brain injury.

• A recent study by the Center for Injury Research and Policy found that 40 percent of high school athletes who suffer a concussion return to their sport prematurely.

• Two states are in the process of enacting legislation to standardize return-to-play criteria.

The news is clear: If your coaches and athletes are not well-educated on concussions, now is the time to change that. More and more research is revealing the extreme danger of this injury and the importance of conservative return-to-play decisions.

"Unfortunately, many people don't recognize the urgency," says Chris Nowinski, a former football player at Harvard University and co-founder of the Sports Legacy Institute, which is dedicated to research and education on concussions and concussion-related brain conditions. "Studies show that the biggest reason players stay in the game when they know they have a concussion is because they have never been taught that it's a serious injury."

Concussions need to be taken seriously for two main reasons: suffering one makes an athlete more susceptible to another, and the cumulative effects can be life threatening. "Multiple studies have shown that the more concussions you get, the less force it takes for you to sustain another one, the longer it takes to recover from that concussion, and the more symptoms you have," says Tracey Covassin, Assistant Professor in the Department of Kinesiology at Michigan State University, who led a study testing the neurocognitive effects of multiple concussions.

Such effects range from decreased neurocognitive performance to depression and dementia, but second impact syndrome (SIS) is likely the most serious. SIS occurs when an athlete suffers an impact to the head before symptoms of a previous concussion have cleared, causing rapid brain swelling. This can lead to severe brain damage or even death, as was the case for two North Carolina high school football players last year.

Among the more disturbing long-term effects of head injuries is Chronic Traumatic Encephalopathy (CTE), a degenerative brain disease believed to be caused by multiple concussive or sub-concussive blows. The disease appears to cause depression, aggressive behavior, memory loss, and impulsivity when the person reaches 40 or 50 years of age.

A recent autopsy study of six former NFL players who died between the ages of 36 and 50 and had suffered concussions during their careers, found signs of CTE in all six. Several of the players committed suicide and abused drugs or made poor financial decisions before their deaths. The researchers also discovered early signs of CTE in a recently deceased 18-year-old who suffered multiple concussions while playing high school sports.

How long should an athlete sit out after sustaining a concussion? Most sports medicine professionals recommend the athlete be completely symptom-free and meet pre-concussion levels on baseline testing, while erring on the side of caution.

In Oregon, the state Senate unanimously passed a bill requiring clearance by a healthcare professional before an athlete can return to play after a concussion, which is being reviewed by the State House. The bill also mandates annual safety training for coaches in all sports. In Texas, a proposed House bill seeks to require preseason baseline neurocognitive testing for all high school University Interscholastic League athletes who play contact sports.

With baseline testing, athletes perform a series of neurocognitive tests at the beginning of the season to measure balance, reaction time, and hand-eye coordination, among other things. When an athlete shows concussion symptoms, they must wait until all symptoms clear and then perform the tests at the same level they did at the beginning of the season before resuming athletic participation.

Many athletic trainers are also more tightly restricting athletes' activity during concussion recovery. "When you're dealing with an injury to the brain, any type of stimulus can aggravate it, especially early on," says Scott Trulock, Head Athletic Football Trainer at the University of North Carolina. "In those first couple of days, we try to reduce overall mental stimulation as much as we can, and that essentially helps the brain rest just as any other tissue needs to rest after injury."

Without an athletic trainer on staff or the ability to administer baseline testing, educating coaches, athletes, and parents is key. "When coaches know what a concussion is, their reporting rates almost always go up," says Nowinski. "They foster a culture of respect for the injury where players are no longer seen as a wuss if they come out of the game with a headache."

Resources can be found at this link:
http://www.athleticmanagement.com/2009/07/17/concussion_education/index.php