Despite efforts by MomsTeam, the Centers for Disease Control (CDC) and others to educate athletes, parents, and coaches about concussions in sport and the dangers they pose, and increased media coverage of the subject prompted by the deaths of high-profile former NFL stars and the disabling of numerous other football players from the long-term effects of multiple concussions, myths and misconceptions about concussions still abound.

Here are some of the most common myths:

How and in what sports do concussions occur?

Myth: A concussion only occurs as a result of a direct blow to the head.

Fact: A concussion may be caused by a direct blow to the head, face, neck, or elsewhere on the body if the blow is transmitted to the head.

Myth: Players suffer concussions only when hit on a particular part of the head and the force of the blow to the head reaches a certain impact magnitude.

Fact: Recent studies of college football players have shown that concussions occur from blows to different parts of the head and of varying magnitude. There is therefore no way to know for certain whether a particular blow will lead to a concussion. A relatively minor impact may result in a concussion while a high-magnitude hit to the head may not.

Myth: Only athletes in aggressive contact sports like football, hockey and lacrosse suffer concussions.

Fact: While football has the highest number of concussions, and concussions are common in hockey, lacrosse and wrestling, concussions also occur frequently in boys' and girls' basketball and soccer.

Myth: Football players participating in helmet-only practices are at lesser risk of concussion because they aren't hit as hard as in games or scrimmages.

Fact: A recent study establishes that head impacts sustained in helmets-only practices are as severe as games or scrimmages. As the study's authors concluded, "There seem to be no ˇ®light' days for football players.

Concussion Signs/Symptoms/Severity

Myth: All concussions are the same.

Fact: No two concussions are identical. The symptoms can be very different, depending on a variety of factors, including the strength and location of the impact, the degree of metabolic dysfunction, the tissue damage and recovery time, the number of previous concussions sustained by the athlete, and the time between injuries.

Myth: A concussion occurs only when an athlete experiences a loss of consciousness (LOC).

Fact: Concussions can occur with or without LOC. In fact, the vast majority of concussions (more than 90%) do not result in LOC.

The most recent consensus of experts is that LOC has limitations as a primary measure of injury severity, so much so that the presence of LOC as a symptom does not necessarily result in classification of the concussion as "complex" under the Prague concussion guidelines, the most recently published international consensus statement on concussion in sport.

Myth: There is a direct correlation between the presence and duration of LOC and concussion severity.

Fact: A brief LOC does not necessarily correlate with concussion severity, despite the fact that it is associated with early neuropsychological deficits. Indeed, the most recent international consensus statement on concussions (2004 Prague statement) recommends that LOC not be relied upon as a measure of concussion severity.

Myth: Temporary confusion or even a permanent gap in memory (post-traumatic amnesia or PTA) can only occur when there is LOC.

Fact: Loss of consciousness is not necessary for there to be the immediate, but temporary, change in brain functions, including PTA, which characterizes a concussion.

Myth: A player who gets "dinged" (sustains a blow to the head resulting in a stunned confusional state that resolves within minutes) hasn't suffered a concussion.

Fact: Such stunned confusional state is still considered a concussion even though the symptoms only last for a very short time. Because the signs and symptoms of concussion may not be apparent until several minutes or hours later, it is essential that a player who has gets dinged be re-evaluated frequently to check to see if a more serious injury has occurred.

Myth: The signs and symptoms of concussion are always apparent immediately after injury.

Fact: While symptoms are often present at the time of injury, they may not appear until several hours later. Athletes, parents and other caregivers need to be alert to the occurrence of such delayed symptoms or deteriorating mental status, which may signal the presence of a serious, life-threatening brain injury such as subdural hematomas (bleeding on the brain) and second impact syndrome.

Concussion Severity & Return to Play (RTP) Guidelines

Myth: All team doctors and certified athletic trainers (ATCs) use the same concussion grading scale in determining concussion severity.

Fact: Because of the lack of scientific studies and the amount of clinical judgment involved in the management of concussions, there is no consensus in either grading the severity of concussions or in when it is safe for athletes to return to play (RTP) after suffering a concussion.

The promulgation during the 1980's and 1990's of no less than sixteen different grading systems for concussions so confused and frustrated sports medicine professionals that many ended up not using any of the grading scales for evaluations purposes.

There are now three major approaches to determining concussion severity in common use: (1) grading the concussion at the time of injury (1991 Colorado Guidelines, 1997 American Academy of Neurology Guidelines), (2) deferring final grading until all the symptoms have resolved (Cantu's 1991 Revised Guidelines) and (3) not using a concussion grading scale at all but instead classifying concussion as simple or complex depending on how long it takes for an athlete to recover (2004 Prague concussion guidelines). For a discussion of these three approaches, click here

Myth: All team doctors and certified athletic trainers (ATCs) follow the same guidelines in determining when an athlete can safely return to play.

Fact: The all important decision of when to allow an athlete to return to play in the same game or practice also continues to be marked by controversy, and no one approach has gained universal approval. Many programs do not follow any set of return-to-play guidelines, and many clinicians believe that the current RTP guidelines are too conservative.

As recently as 2000, nearly one-third (30%) of all high school and collegiate football players sustaining concussions were allowed to return to competition on the same day of injury, with the remaining 70% averaged 4 days of rest before return-to-play (RTP).

Unfortunately, such liberal departures from RTP guidelines - many of which call for an athlete to be symptom free for at least 7 days before returning to play after a grade 1 (mild) or 2 (moderate) concussion - may end up putting athletes at increased risk of a second concussion, which, in athletes under age 18, could have catastrophic consequences (e.g. second impact syndrome).

Myth: It is safe for a player to return to the same game or practice if he suffers only a brief LOC.

Fact: The strong trend under the most recent international consensus statements on concussions (Vienna, 2001; Prague, 2004) is to take a more conservative approach under which a player who suffers ANY concussion signs or symptoms of concussion is NOT allowed to return to the current game or practice, following the philosophy "When in doubt, sit him out."

Two 2003 studies suggest that a 7-day waiting period may minimize the risk of another concussion. Not only does the evidence show that athletes take, on average, 7 days to fully recover after a concussion, but same-season repeat injuries typically take place 7 to 10 days after the first, which supports the idea that the brain may more vulnerable to injury during the first 7 days after injury.

Myth: It is safe for a player to return to the same game or practice if, after suffering a concussion, he is symptom free within 15 or 20 minutes, both at rest and with exertion?

Fact: Under the three concussion RTP guidelines most widely used in the 1980's and 1990's (and still in use today) an athlete is allowed to return to play in the same game if his post-concussion signs or symptoms clear within 15 minutes (American Academy of Neurology, 1997) or 20 minutes of injury (Colorado Medical Society, 1991) of injury, or when he is symptom free both at rest and following physical exertion (Cantu, 1986).

Recent studies of high school and collegiate athletes emphasize the importance of making sure that an athlete is symptom free before being allowed to return on the same day because even if the athlete is symptom free within 15 or 20 minutes, he may still have delayed symptoms or cognitive functioning. One study found significant memory deficits 36 hours post-injury in athletes who were symptom-free within 15 minutes of a mild concussion. Another found that nearly three times as many concussed athletes who were allowed to return the day of injury experienced delayed onset of symptoms 3 hours post-injury as athletes who sat out the rest of the game or practice.

More recent return-to-play guidelines, such as those issued in 2005 after the Second International Conference on Concussion in Sport in Prague, recommend that a player who exhibits ANY symptoms or signs of a concussion NOT be allowed to return to play in the current game or practice regardless of how quickly the symptoms clear, and be fully symptom free for at least 7 days at rest and during exercise before returning to play.

Concussion Management in Youth Sports

Myth: Concussions suffered by athletes under the age of 18 can be managed the same way as concussions suffered by adult athletes.

Fact: Experts generally agree that concussions in athletes under age 18 should be managed more conservatively due to the fact that they are more susceptible to subsequent concussions and because damage to the maturing brain of a young athlete, in rare cases, can lead to coma or death (At least 50 high school or younger football players have died or sustained catastrophic head injuries since 1997 from second impact syndrome).

Myth: Youth athletes recover from concussions at the same rate as older athletes.

Fact: Studies suggest that there are age-related differences between high school and college athletes in terms of recovery. High school players are more susceptible to post-concussion syndrome and serious injury than college or professional players, their developing brains take longer to heal, and they are more prone to subsequent concussions. Studies have also shown that high school athletes who suffered concussions experienced more prolonged problems with memory than college athletes and performed significantly worse on memory tests 7 days post-injury compared to college athletes.

Myth: Girls suffer concussions at the same rate as boys.

Fact: According to a 2007 study, girls appear more susceptible to concussions in sports like soccer and basketball than boys. Girls playing high school soccer suffer concussions 68 percent more often than boys playing the same sport. Female concussion rates in high school basketball were almost 3 times higher than for boys.

The reasons concussion rates are consistently higher for girls than boys in the same sport are unclear, but experts speculate that they may be due to anatomical (less developed neck muscles) and cultural differences (coaches and parents may be more sensitive to injury to the female head, girls may self-report at higher rate than boys). "Generally speaking, the medical profession does not do a very good job in recognizing that female athletes sustain concussions at an equal or even higher rate as males," MomsTeam expert Dr. Robert Cantu of Brigham and Women's Hospital in Boston told The New York Times. "It's flying under the radar. And, as a result, looking for concussions in women is not pursued with the same diligence, and it's setting girls up for a worse result."

Myth: Girls recover from concussions at the same rate as boys.

Fact: A 2007 study found that girls took much longer than boys for symptoms to resolve and to return to play.

Myth: Most athletes know when they have suffered a concussion and report them to their coach, athletic trainer or team doctor.

Fact: Most athletes do not understand precisely when they have suffered a concussion (many still think that it requires LOC), and wouldn't tell the coach even if they knew they had sustained one. The macho culture of sports, particularly in such aggressive contact sports as football, hockey, and lacrosse, puts athletes under significant pressure to "shake off" a concussion or "take it like a man" - pressure that coaches and parents often exacerbate, either directly or indirectly or subtly, in their desire for team and individual success - which results in a drastic underreporting of concussions and can lead to serious harm (e.g. second impact syndrome). There is also a tendency of young players to imitate N.F.L. players, many of whom are afraid to report a concussion because it might affect their next contract.

Athletes need to understand the signs and symptoms of a concussion as well as the range of negative consequences of not reporting a concussion, from predisposition to future concussions to long-term cognitive and emotional difficulties (e.g. depression) to catastrophic injury (e.g. second impact syndrome).

Safety Equipment

Myth: Mouth guards reduce the risk of concussion.

Fact: There is no scientific evidence supporting their use for reducing concussive injury. A properly fitted mouth guard, regardless of type (boil-and-bite or custom-made), should nevertheless be worn because of its value in protecting the teeth and preventing fractures and avulsions that could require many years of expensive dental care.

Myth: All football helmets reduce the risk of concussion.

Fact: Most of the football helmets currently in use do little if anything to protect brains from the forces that cause concussions. But technological advances in helmet design, while they may not make concussions in football a thing of the past, have made a significant reduction in the number of concussions a reality. A three-year study of high school athletes from Western Pennsylvania reported that athletes wearing one type of the new helmets had a 31 percent decreased risk of concussion. An innovative new helmet using air based shock absorbers, which will be on the market in time for the 2008 football season, also offers the promise of increased protection against concussion.

Myth: Soccer headgear is ineffective in protecting athletes against concussions.

Fact: While a 2005 British study sponsored by the sports medicine committee of FIFA, soccer's world governing body, found that headgear provided no measurable benefit in head-to-ball impacts, it concluded that headgear did provide measurable benefit in head-to-head impacts. A 2007 study by researchers at Canada's McGill University found that teenage soccer players wearing protective headgear suffered nearly half as many concussions as those who played without helmets. The study also seemed to show that wearing headgear did not encourage soccer players to play more aggressively, as some had feared.

Author: Lindsay Barton
Date created: March 15, 2008
Copyright: MomsTeam.com, Inc.

	Reprint Policy Return to Head Injury Home Page

Related Articles

 Concussion Severity & Return to Play: Prague Consensus Statement
 Concussion Grading Systems And Return-To-Play Guidelines: A Comparison
 Concussions Linked to Depression Study Says
 Second Impact Syndrome: What Is It?
 Second Impact Syndrome: Reasons To Be Cautious With Even Mild Concussions
 Soccer Headgear Cuts Concussion Risk in Half, Study Says
 Preventing Mouth Injuries: The Importance Of Mouth guards

For more on this topic

 What are Concussions?
 Post-Concussion Signs & Symptoms: A Checklist
 Post Traumatic Amnesia
 Determining Loss Of Consciousness In Athletes

Printer-friendly Version

Send MomsTeam Feedback