If you play a contact or collision sport, whether at the youth, middle school or high school level, there is a pretty good chance that at some point in your athletic career, you have had your "bell rung" or been "dinged" at some point (likely more than once). 
If you are like most athletes, you may not appreciate precisely when you have suffered a concussion (especially since symptoms may not appear right away), or because you don't understand the symptoms or do not appreciate the seriousness of brain injury, [1,2,3,9,10] or think that you need to experience a loss of consciousness (LOC)  in order to have suffered one - even though it is a myth that concussion requires such a black out, and 90-95% of all concussions in high school sports do NOT involve an LOC. 
Even if you suspect you have suffered a concussion, like a lot of athletes (as many as 40% according to a 2013 study ) you may be reluctant to self-report symptoms of a concussion because your parents, your coach, and the very culture of the contact or collision sport you are playing encourages you to remain silent in order to:
When interviewed by MomsTEAM's Brooke de Lench for the PBS documentary, "The Smartest Team: Making High School Football Safer ," nearly every football player at one Oklahoma high school acknowledged that they would not self-report concussion symptoms:
But know this: If you don't tell anyone that you or a teammate are experiencing concussion symptoms and continue to play, you are putting yourself or your teammate at increased risk of more serious brain injury, a longer recovery time, and, in very rare circumstances, catastrophic injury or even death (e.g. second impact syndrome ).
Several years ago, a segment of HBO's Real Sports on high school sports concussions featured the tragic story of Ryne Dougherty, a Montclair, New Jersey football player who died in 2008, likely from second impact syndrome, when he suffered a blow to the head when he returned to play, despite having confide to teammates that he was still experiencing headaches from an earlier concussion.
As needless as Ryan's death was, even more shocking was that his teammates, when asked if, knowing what they knew now about the dangers of playing with concussion symptoms, they would still hide their concussion symptoms in order to play, they still all answered without equivocation, "Yes."
Indeed, an ESPN poll of players, coaches, parents and athletic trainers in 23 states  found that players like you - the ones whose brains are being rattled and who are putting yourself at risk of adverse long-term health consequences from concussions - are still the group least concerned about concussions.
When asked whether, if a star player got a concussion, they would rather lose the state title game as he sat out than win it because he chose to play with a concussion, more than half (54.1%) of the 300 players in the ESPN survey said they would play the star compared to 9% of athletic trainers, 6.1% of parents, and 2.1% of coaches. A majority of players (55.4%) also felt that a headache - far and away the number one reported symptom of concussion  - shouldn't disqualify them from returning to the same game.
It is therefore critically important, as an athlete playing a contact or collision sport (including not only football, hockey and lacrosse, but soccer, basketball, cheer, and baseball), that you understand the symptoms of a concussion (things you feel) as well as the range of damaging health consequences of not reporting them, from making another concussion much more likely  to long-term cognitive (concentration, memory, reasoning) and emotional difficulties (e.g. depression ) to catastrophic injury or death (e.g. second impact syndrome ).
Not only do you need to report your own symptoms, but, if your teammates tell you they are experiencing concussion symptoms, you should urge them to report them to some responsible adult, whether it be the coach, athletic trainer, school nurse, or parent. By doing so, you may be literally saving their lives.
|Symptom Evaluation: |
How do you feel?
|Time of Injury||2-3 hours post-injury||24 hours post-injury||48 hours post-injury||72 hours post-injury|
|"Pressure in head"|
|Nausea or vomiting|
|Balance problems |
|Sensitivity to light
|Sensitivity to noise|
|Feeling slowed down
|Feeling like "in a fog"
|"Don't feel right"|
|Difficulty concentrating |
|Difficulty remembering |
|Fatigue or low energy
|Loss of orientation|
|Trouble falling asleep|
|Nervous or anxious
It is also critically important that you NOT return to play before your symptoms have cleared. As anxious as you may be to return to the playing field, coming back too soon, before your brain has fully healed, will likely delay your recovery, but could have tragic consequences. Because your brain is still developing, a second blow to your head before your symptoms have completely cleared, not only at rest but with exercise , could lead, in rare instances, to an often fatal condition called second impact syndrome .
One recent study   suggests that, if you are like most athletes, in gauging your own readiness to return-to-play you are likely to rely most heavily on the absence of somatic (e.g. physical) symptoms  such as headache, vomiting and visual disturbances - which are more apparent and easier for you or those around you to directly observe - and much less on the more elusive and subtle symptoms of concussion such as "fogginess," difficulty concentrating or remembering, and slowed reaction time - symptoms which are harder for you to detect. The study also found that, if you are like most athletes, your awareness of your own cognitive decline after concussion is limited.
"The results of the study indicate youth athletes are basing their perceptions of recovery from concussion primarily on overt, physical symptoms such as headache and nausea, and may neglect to consider the cognitive symptoms of the injury, says lead author of the study, Natalie Sandel, B.S., then of the Department of Neuroscience and Dietrich School of Arts and Sciences at the University of Pittsburgh.
Another recent study  found that about a quarter of athletes who report being asymptomatic after exercise - which is a prerequisite to return to play - scored significantly less than their baseline on neurocognitive tests of verbal and visual memory, so that, absent honest self-assessment of symptoms after exercise and neurocognitive testing, there is a risk that you will be allowed to return to play before your brain has fully healed.
The bottom line: be honest, be smart, and, when in doubt, sit the game out!
1. McGrath N. Supporting the Student-Athlete's Return to the Classroom After a Sport-Related Concussion. J Ath. Tr. 2010:45(5):492-498.
2. McCrea M, Hammeke T, Olsen G, Leo P, Guskiewicz K. Unreported concussion in high school football players - Implications for prevention. Clin J Sport Med 2004;14:13-17.
3. Tomei KL, Doe C, Prestigiacomo CJ, Gandhi CD. Comparative analysis of state-level concussion legislation and review of current practices in concussion. Neurosurg Focus 2012; 33 (6):E11 (published online ahead of print)(accessed December 10, 2012).
4. Meehan W, d'Hemecourt P, Comstock D, "High School Concussions in the 2008-2009 Academic Year: Mechanism, Symptoms, and Management" Am. J. Sports. Med. 2010; 38(12): 2405-2409 (accessed December 2, 2010 at http://ajs.sagepub.com/content/38/12/2405.abstract?etoc )
5. Echlin PS, Skopelja EN, Worsley R et al. A prospective study of physician-observed concussion during a varsity university ice hockey season: incidence and neuropsychological changes. Part 2 of 4. Neurosurg Focus 2012;33(6):E2.
6. "Concussion Confidential" ESPN The Magazine (http://sports.espn.go.com/espn/news/story?id=5925876 )(accessed December 21, 2010).
7. Sandel N, Lovell M, Kegel N, Collins M, Kontos A. The Relationship Of Symptoms and Neurocognitive Performance to Perceived Recovery From Sports-Related Concussion Among Adolescent Athletes. Applied Neuropsychology: Child. 2012; DOI:10.1080/21622965.201 2.670680 (published online ahead of print 22 May 2012)(accessed June 5, 2012).
8. McGrath N, Dinn WM, Collins MW, Lovell MR, Elbin RJ, Kontos AP. Post-exertion neurocognitive test failure among student-athletes following concussion. Brain Injury 2013;27(1):103-113.
9. Register-Mihalik JK, Guskiewicz KM, Valovich McLeod TC, Linnan LA, Meuller FO, Marshall SW. Knowledge, Attitude, and Concussion-Reporting Behaviors Among High School Athletes: A Preliminary Study. J Ath Tr. 2013;48(3):000-000. DOI:10.4085/1062-6050-48.3.20 (published online ahead of print)
10. Kroshus E, Daneshvar DH, Baugh CM, Nowinski CJ, Cantu RC. NCAA concussion education in ice hockey: an ineffective mandate. Br J Sports Med. 2013;doi:10.1136/bjsports-2013-092498 (epub. August 16, 2013)
11. Chrisman SP, Quitiquit C, Rivara FP. Qualitative study of barriers to concussive symptom reporting in high school athletics. J Adolesc Health 2013;52:330-5 e3.
Most recently revised September 3, 2013