One of the most commonly known prevention strategies to reduce the potential for a sports and recreation (SR)-related TBI, including concussion, is the proper use of personal protective equipment. However, sports helmets are designed to prevent severe and fatal injuries (e.g., skull fracture, penetrating injuries, and severe brain injuries) rather than preventing all concussions. Sports helmets may reduce the incidence or severity of SR-related head injuries by reducing potential impact forces.
In SR activities, the external forces may cause linear, rotational, or angular movement of the brain, or a combination of these motions. In rotational forces, for example, the magnitude of this force may be an important factor to cause a concussion and may even contribute to its severity. It has been estimated that angular accelerations ranging from 4,600 to 7,900 rad/s2 may increase the risk of developing a mild TBI from 25% to 80%. Although many areas of the brain can be affected by rotational forces, these may primarily affect the midbrain and the diencephalon disrupting parts of reticular activating system; which in turn, may result in loss of consciousness. It is thought that concussion results from a diffuse brain injury affecting mainly axons distributed over a widespread area of the brain or inadequate blood flow to the brain due to other concurrent injuries.
Source: Matthew Gfeller Sport-Related TBI Research Center, University of North Carolina at Chapel Hill.
Helmets and other protective equipment should fit properly, be appropriate for the position or activity, be well maintained, and be consistently and correctly used. Among skiers and snowboarders, wearing protective equipment, like helmets, has been effective in diminishing potential head injuries. Studies focusing on newer football helmet technologies have found decreases in absolute and relative risk for sustaining concussions and a potential 10-20% reduction in risk of concussion in recreated collisions from the NFL. Despite advancements in protective equipment, those who engage in SR activities are still vulnerable to injuries as the use of effective protective equipment is not always mandatory or available in non- or partial-contact sports such as lacrosse or field hockey. Some of the difficulties in sports concussion prevention may stem from the lack of a universal definition and a common belief that concussions are “part of the game”.
By taking this training- and taking concussion seriously—you’ve shown your dedication to your athletes and their safety.
Now, it’s time to take what you’ve learned to your coaching staff, team, parents, school professionals, and community. Generating the support you’ll need when it comes to identifying and responding to a concussion now will help later when you need to pull out an athlete because you suspect a concussion.
Use the following preparedness checklists to guide you through pre- , mid- , and post-seasons.
Check with your league, school, or district about concussion policies.
- Concussion policy statements should include the school or league’s commitment to safety, a brief description of concussion, and information on when athletes can safely return to play. Parents and athletes should sign the concussion policy statement at the beginning of each sports season.
- Win the support and involvement of other school or league officials—such as principals, certified athletic trainers, other coaches, school nurses, and parent-teacher associations—to help ensure that school rules and concussion policies are in place before the first practice.
Create a concussion action plan.
To ensure that concussions are identified early and managed correctly, have an action plan in place before the season starts. You can use the “Heads Up” four-step action plan and include it in your league, school, or district’s concussion policy.
Educate athletes, parents, and other coaches about concussion.
Dedicate a team meeting to talk about concussion and before the first practice, talk to athletes, parents, other coaches, and league and school officials about the dangers of concussion; potential long-term consequences of concussion; and your concerns as well as your expectations of safe play.
Show concussion videos available on CDC’s website. Pass out concussion fact sheets for athletes and for parents at the beginning of the season, and again if a concussion occurs.
Remind athletes to immediately tell the coaching staff if they suspect that they have a concussion or that a teammate has a concussion.
Monitor the health of your athletes.
Review the signs and symptoms of concussion, and keep the “Heads Up” four-step action plan with you at games and practices. (Carry the “Heads Up” clipboard with you and fill out the pocket card or clipboard sticker so that information about signs, symptoms, and emergency contacts is readily available.)
Make sure to ask if an athlete has ever had a concussion, and insist that your athletes be medically evaluated and in good condition to participate.
Prior to the first practice, determine whether your school or league has or would consider conducting pre-season, baseline testing. Also known as neurocognitive tests,these tests help assess brain function (including learning and memory skills, ability to pay attention or concentrate, and how quickly someone can think and solve problems) and can be used again during the season if an athlete has a concussion, to identify the effects of the injury. Identify the appropriate health care professional to run this program.
Insist that safety comes first.
- Teach and remind athletes of safe-playing techniques. Encourage them to follow the rules of play; to practice good sportsmanship at all times; and to consistently wear the right protective equipment (that fits properly, is well-maintained, and worn correctly) for their activity.
Teach your athletes that it’s not smart to play with a concussion.
- Remind your athletes and everyone who influences them—teammates, fans, parents, fellow students—playing with a concussion is dangerous.
Work closely with other league or school officials.
- Be sure that appropriate staff is available for injury assessment and referrals for further medical care.
- Enlist certified athletic trainers, school nurses, or appropriate school or league officials to monitor any changes in the athlete’s behavior or school work that could indicate that the student has a concussion. Ask them to report concussions that occurred during the season. This will help in monitoring injured athletes who participate in multiple sports throughout the year.
- Keep a concussion log.
- Work with a certified athletic trainer, school nurses, and other school or league staff to review injuries that occurred during the season. Discuss with other staff any needs for better concussion prevention or response preparations.
- Review your concussion policy and action plan.
- Discuss any need for improvements to your concussion policy or action plan with appropriate health care professionals and league or school staff, especially in light of what your log reveals.
|Phase||Host||Agent/Vector||Physical Environment||Socio-Economic Environment|
|Pre-Event||Request medical clearance from participants||Use age appropriate protective equipment||Ensure availability of appropriate surface and lighting conditions||Educate parents about practices of good sportsmanship|
|Event||Wear age appropriate protective equipment||Reduce animosity between players through enforcement of game rules||Pad posts of goals to dissipate energy||Strengthen rules for return to play|
|Post-Event||Train people in first aid after a suspected concussion||Encourage injury reporting by victims or team mates||Ensure availability of emergency call systems to reach medical responders||Strenghten public health infrastructure to properly assess the burden and determine injury related risk factors|
Adapted from: Haddon, W. Advances in the epidemiology of injuries as a basis for public health. Pub Health Rep 95:411-421, 1980.
There are many ways to reduce the chances of a concussion or other form of TBI,including:
1. Wearing a seat belt every time you drive or ride in a motor vehicle.
2. Buckling your child in the car using a child safety seat, booster seat, or seat belt (according to the child’s height, weight, and age).
- Children should start using a booster seat when they outgrow their child safety seats (usually when they weigh about 40 pounds). They should continue to ride in a booster seat until the lap/shoulder belts in the car fit properly, typically when they are 4’9” tall.
3. Never driving while under the influence of alcohol or drugs.
4. Wearing a helmet and making sure your children wear helmets when:
- Riding a bike, motorcycle, snowmobile, scooter, or all-terrain vehicle;
- Playing a contact sport, such as football, ice hockey, or boxing;
- Using in-line skates or riding a skateboard;
- Batting and running bases in baseball or softball;
- Riding a horse; or
- Skiing or snowboarding.
5. Making living areas safer for seniors, by:
- Removing tripping hazards such as throw rugs and clutter in walkways;
- Using nonslip mats in the bathtub and on shower floors; Installing grab bars next to the toilet and in the tub or shower;
- Installing handrails on both sides of stairways;
- Improving lighting throughout the home; and
- Maintaining a regular physical activity program, if your doctor agrees, to improve lower body strength and balance.
6. Making living areas safer for children, by:
- Installing window guards to keep young children from falling out of open windows; and
- Using safety gates at the top and bottom of stairs when young children are around.
7. Making sure the surface on your child’s playground is made of shock-absorbing material, such as hardwood mulch or sand .