The majority of sports-related traumatic brain injuries are concussions with 1.6 to 3.8 million sports-related concussions occurring annually in the United States. The number of concussions diagnosed continues to rise due to enhanced public awareness and concerns regarding such injuries. 

Some factors predict longer recovery time and these include a history of concussions, birth trauma, paediatric head injury, seizures, migraines, neurodevelopmental disorders, attention deficit hyperactivity disorder, learning disabilities, sleep disorders, motion sickness, mood disorders, and psychosocial stress. Right after the injury, loss of consciousness, amnesia, and a greater number of symptoms observed on the field predict a longer recovery time.

Which factors increase the risks of sports-related concussions?

• Age: Children between the ages of 10-14 have the highest incidence of sports-related TBIs recorded at emergency rooms. The majority of these injuries are produced by recreational activities like bicycling, football, and playground activities. For high-schoolers, football and soccer have the highest concussion rates but more generally, collision and contact sports such as hockey, basketball, and football have higher concussion rates than non-contact sports like track. 90% of collegiate athletes return to baseline cognitive function within 2 weeks of their concussion. On the other hand, high school athletes take longer to recover where only 50% return to baseline after 7-10 days and 90% of them reach baseline within 4 weeks.

• Gender: For males, football causes the highest rate of concussions but soccer is what leads to the highest numbers of concussions in females. Interestingly, females have almost twice the rate of concussions compared to males, even in sports that follow the same rules. It is hypothesized that this is due to physiological differences such as reduced skull thickness, smaller neck muscles, and hormonal factors. Another hypothesis suggests that this discrepancy is due to females being more willing to report their injuries than males.

Not engaging in sports is not the correct way to avoid concussions, instead, some steps can be taken to minimize the risk and ensure a safe return to play:

•  Education: Athletes, coaches, parents should all be educated regarding the symptoms of concussions and the risks involved which will increase the likelihood of reporting them.

• Safe play guidelines: The Centers for Disease Control (CDC) has specific safety guidelines to minimize concussion risks associated with sports. Adhering to such rules will create a safer and fairer environment for the athletes.

• Equipment: Using helmets and mouthguards when necessary can reduce the impact of the injury on the brain.

• Strength and conditioning: Aerobic conditioning prior to concussion minimizes recovery time and having strong neck muscles could reduce the risk of concussions as well.

• Removal and rest: It is absolutely crucial to remove any players suspected of having a concussion from the game. Longer recovery times have been recorded for players who played through their symptoms compared to those who were immediately removed from play after their injury. Resting for the first few days is important to avoid sustaining another concussion which could exacerbate the symptoms. 

• Graduated re-entry: the Centers for Disease Control and Prevention published return-to-play steps to help athletes safely return to their sports. Each step has to be completed without the presence of any symptoms before proceeding to the subsequent stages. There are 6 stages in total: Baseline (no symptoms), light aerobic activity, moderate activity, heavy non-contact activity, practice and full contact, and finally competition. Monitoring the progression through these stages will ensure the safety of the athletes once they return to their full playing capacity.

Written by Lea Farah

References

Conder, R. L., & Conder, A. A. (2015). Sports-related concussions. North Carolina Medical Journal (Durham, N.C.), 76(2), 89-95. https://doi.org/10.18043/ncm.76.2.89

Giza, C. C., & Kutcher, J. S. (2014). An introduction to sports concussions. Continuum (Minneapolis, Minn.), 20(6), Sports Neurology, 1545-1551. https://doi.org/10.1212/01.CON.0000458975.78766.11

Giza, C. C., Prins, M. L., & Hovda, D. A. (2017). It’s not all fun and games: Sports, concussions, and neuroscience. Neuron (Cambridge, Mass.), 94(6), 1051-1055. https://doi.org/10.1016/j.neuron.2017.05.003

Hobbs, J. G., Young, J. S., & Bailes, J. E. (2016). Sports-related concussions: Diagnosis, complications, and current management strategies. Neurosurgical Focus, 40(4), E5. https://doi.org/10.3171/2016.1.FOCUS15617