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The Concussion Conundrum: An in Depth Look at Concussion
Seth Halman
Abstract
concussions. Giving a brief overview of what a concussion is and the impacts that they can have.
The author explains the necessity of protocols and procedures for the management of
concussions and the recovery process. Going over some of the legal issues that the NCAA and
professional sports organizations have faced. Along with their individual policies and procedures
for dealing with concussions. The Author ends with a breakdown of legislation that is important
A concussion is a bruise to the brain no matter how major or minor; received during
some sort of athletic competition or practice. They are caused by some sort of impact to the head
or neck region, causing the brain to rattle or bounce against the side of the skull. This results in a
bruise on the brain, otherwise known as a concussion, which will cause symptoms such as
affected memory, reflexes, speech judgement, balance, and motor skills. Concussions can also
leave the affected athlete in a groggy state or a fog which can make it hard to pay attention or
process information. The reason I chose concussions as my topic of research and discussion is
the want to learn more about something that has deeply affected me on a personal level. Having
multiple concussions in my athletic career I know how they can affect a person. Receiving my
first concussion wrestling at the Junior Olympics my Sophomore year of highschool, I woke up
lying flat on the mat with trainers around me asking me questions about where I was and what
day it was. Mean while I was in a fog not knowing where I was. It took me almost a month to
recover before I was able to work back into practicing and participating again. Although I was
highly fortunate in having a highly qualified doctor and well run training staff at my school
during my recovery. Having other concussions since then it gives me a greater understanding of
how important the recovery process is in terms of long term health. Emphasis needs to be put on
the recovery process in terms of protocols and legislation. Due to the danger that is attached to
improper management of recovery from a concussion, such a second impact syndrome and CTE.
What is a Concussion
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Concussions are an injury to the brain that result in a slow down of normal brain function
usually coming as a result of a blow to the head. The blow or impact causes the brain to move
back and forth inside of the skull forming a bruise on the brain, damaging brain cells, and
causing chemical imbalances in the brain. With concussions resulting in affected memory,
reflexes, speech judgement, balance, and motor skills ("American Association of Neurological
Surgeons ," n.d.). While a direct impact to the head is the most common cause of concussion in
athletics, there is also what is known as a rotational concussion. This is when the head is jolted or
there is a sort whiplash involved. This causes the brain to move rapidly inside the skull and hit
against the inside of the skull. This has all of the negative impacts that are associated with a
Concussions in Sports
Annually there are 300,000 concussions in High School and Collegiate athletics, now the
second highest cause of traumatic brain injuries behind automobile accident (Gessel, Fields,
Collins, Dick, & Comstock, 2007). With a youth athlete suffering a sports related concussion
once every three minutes as the national average. Although it is not just football where these
injuries are occurring. Concussions also occur in not contact sports that are not generally
suspected. With the rate of concussions also being higher in girls versus boys when you compare
a sport that both genders play. In basketball 11.5 percent of girls who played suffered from a
concussion compared to 7.2 percent in boys. The same statistics are found when looking at youth
soccer with 17.1 percent of girls suffering from concussions compared to 12.4 percent of boys.
There is no known connection that gives explanation to why girls are at a higher risk of suffering
a sports related concussion than guys are ("Concussion Care Belongs at the Top of Every Youth
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Sports Playbook," n.d.). In high school athletics concussions make up fifteen percent of all
Once an athlete has suffered their first concussion, it is even more important that they are
not only informed but strictly adhere to concussion protocols. Due to the fact that once an athlete
has a concussion, they are up to three times more likely to receive a second one ("Statistics,"
n.d.).
One of the biggest long term affects to receiving too many concussions during a given
athletic career is CTE, Which is a degenerative disease that causes a progressive breakdown in
the brain.It has long term effects that mirror dementia with the full list of symptoms including:
memory loss, confusion, impaired judgement, trouble controlling impulses, aggression, and
depression ("What Is CTE? CTE Center | Boston University," n.d.). CTE is related to the a
protein called Tau. Tau starts to form inside the brain after repetitive trauma, and the protein
starts to eat away at the brain cells. This is a process that may not begin until an extensive period
of time from the last suffered trauma or concussion. There are some cases of professional
athletes who have developed CTE multiple decades after they have stopped playing ("What Is
CTE?," 2016).
Although CTE can lead to many horrible effects on the brain long term, it is not the most
severe impact that a concussion can have upon an individual. Second impact syndrome poses the
biggest threat to an individual's health. Second impact syndrome occurs when an individual
sustains a concussion and does not report the symptoms or is not given a proper evaluation. The
individual returns to athletic participation and receives a second concussive blow. This can cause
the brain to begin to swell inside the skull without room for the said expansion to occur. Second
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impact syndrome can cause brain damage and death (Bey & Ostick, 2009). In cases where
second impact syndrome has been reported, death has occurred fifty percent of the time
("Statistics," n.d.).
Return to play protocol is important when dealing with concussions on all levels of
athletics. They allow for athletes to gradually be eased back into participation allowing for their
brain to fully heal. As an athlete's long term health is the most important issue when dealing with
the recovery from a concussion (M. Midkiff, Personal communication, November 10, 2016).
The CDC recommends that all return to play progressions take a minimum of five steps.
All progressions follow the same basic guideline of light activity, moderate activity, non contact
sports drills, full speed practice, with a return to play coming as a result of the completion of the
progression as the fifth step. It is also important to note if an athlete is to begin having any signs
or symptoms while working through a specific stage of the progression. They should stop for the
day and return back to the previous step on their progression chart. All athletes should also have
a baseline cognitive test so the same examination can be done after a concussion occurs and the
It is highly important for all athletes who sustain a concussion to go through a return to
play protocol. The standards need to be higher for the return of a youth athlete. This is due to the
fact that the brain of an adult can heal faster than an adolescents can. Youth athletes needing to
pass their cognitive test before they begin their progression instead of after the progression
before they return to play. It is also important that the progression is spaced out for a youth
athlete, with every step of the progression occurring on a separate day allowing for an increased
period of time for the brain to heal. Since a concussion can cause an extended leave in relatively
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shorter high school athletic season, the athletes return should be supervised by an athletic trainer
instead of a coach. This removes the possibility of a coach being put into a situation where they
must choose between what is potentially best for the team and an individual's long term health.
Along with having the process required to be supervised by an individual that is qualified to
oversee it along with having a medical background (M. Midkiff, Personal communication,
The NCAA and various athletic conferences, such as the SEC, are receiving lawsuits
from former players who suffer from chronic issues related to concussions sustained during their
playing time. Issues are related to suffering concussive and subconcussive blows during their
playing times at their respective schools due to the fact that the players played before the NCAA
held a sufficient return to play policy (Morales, 2016). It is necessary to monitor the recovery of
a player and prevent them from competing in contact sports while still displaying concussive
symptoms. In addition to smaller lawsuits, the NCAA has recently settled a major seventy five
million dollar class action lawsuit in July 2016. With the money being put into two different
causes, seventy million dollars worth will be used to set up, and run a medical monitoring system
that will make medical screening and Medical Evaluations available to all current and former
NCAA student-athletes regardless of when they played, what sport they played, for how long
they played, in which state they played or reside, or their age (Sports, 2016). The other five
million dollars will be put into funding concussion research, with the research being focused
Return to Play
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The NCAA holds a high standard for concussion regulations requiring each school to
have a concussion management plan. With each plan having preset standards for return to
activity, return to play, and return to academics, allowing for every athlete to be eased back into
participation in each individual area. It is also necessary for collegiate athletic programs to make
their plan readily available for viewing. This will make sure that all athletes, coaches, or other
involved parties are educated about all procedures and standards ("Concussion Management and
Every concussion management plan has four key components that must be followed by
the schools. All athletes, coaches, medical staff, and individuals directly involved in an athletic
program must receive adequate medical information every year. Along with a returned signed
acknowledgment of receiving the necessary information, showing that the school has covered
their obligation to inform the students. Baseline concussion testing must also be performed
before and athlete is allowed to participate in NCAA sanctioned athletics. With testing including
the athlete, and a balance evaluation. All of the testing should be completed by an approved team
doctor. The team doctor also possess the ability to have additional testing done on the athlete if
they feel it is necessary ("Concussion Management and Diagnosis Best Practices," 2016).
All athletes that exhibit signs or symptoms of a concussion must be removed from any
athletic activity immediately and be evaluated by an approved athletic trainer or doctor. The
athlete is checked for all of the signs of concussion, along with being given tests for cognitive
function and balance. With athletes who exhibit any signs being removed from athletic
participation immediately and entered into the concussion protocol. The exact protocol for
physical activity if the individual is at baseline before starting the protocol and remains at
baseline throughout each step of the protocol. It is noteworthy that all return-to-play
guidelines are consensus-based and have not been validated by evidence-based studies.14-
15
McCrea and colleagues16 have reported that a symptom-free waiting period is not
are based on expert consensus. ("Concussion Management and Diagnosis Best Practices,"
2016)
With the actual six step progression being listed as follows: light anaerobic exercise, moderate
resistance training, activity specific to the athlete's sport, non contact drills, full contact practice,
and finally a return to play. If an athlete becomes affected by any concussions symptoms while
working through their progression activity is to be stopped and they are to return to the previous
Along with a protocol for returning to play, the NCAA also has set rules and regulations
to help an athlete in their return to academics. This is due to the fact that cognitive activity
requires more use of the brain then when compared to physical activity. However, the procedures
for return to academics are not as strict as the procedures set forth to outline return to play. This
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is due to the fact that academics can become challenging to an athlete suffering from a
concussion. They do not pose the same threat of increased injury that physical activity does. The
first step to returning to academics is very similar to that of returning to athletics: rest. This is the
removal of all cognitive stressors not just school work. The list includes: school work, reading,
texting, playing video games, watching television, and anything else that will put stress on the
brain. While the NCAA expressly states that a break from academics should be a minimum of the
rest of the day on which the concussion occurred. Every situation is unique and the student
athlete should discuss with the trainer to build a more individual time table for initial rest. The
return to academics not beginning until the student athlete can complete basic activities that
require cognitive function without displaying concussion symptoms. The student athlete should
make a gradual return to the classroom once they are able to break that threshold. Student
athletes whose symptoms are persisting past two weeks should contact the disability services
office to have special accommodations made ("Concussion Management and Diagnosis Best
Practices," 2016).
The National Football League is the professional sports league most troubled by the long
term impacts of concussions. With players suing the league for the effects of long term
degenerative diseases connected to concussions sustained during their playing time. This can be
best displayed in a settlement between the NFL and The NFL Players Association from 2014.
The case Re National Football League Players Concussion Injury Litigation involves the
litigation between the NFL and the NFL Players Association, regarding to the long term effects
that concussive and subconcussive blows have had on former players. This includes CTE and
other degenerative diseases that can be connected to concussions. The 650 million dollar
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settlement set aside money to compensate former players who suffer from degenerative diseases,
along with providing for better safety measures for current players, and concussion education.
As more information starts to come in about players having adverse effects from
concussions sustained during their playing time, the NFL has attempted to raise safety standards
with player safety becoming the biggest concern in the game today. New rule changes to the
concussion protocol call for an independent neurotrauma specialist to check out players if they
are suspected of sustaining a concussion while playing. This removes any pressure that was
previously put on team doctors to clear key players to return into games when it was unsafe for
them to do so. Along with medical trainor's that now watch games to specifically look for players
who are taking big hits on the field, or displaying possible signs of a concussion if a player is
spotted the medical staff has the power to stop the game to allow for the player to be removed
from the field and for an evaluation to begin (Associated Press, 2016). The NFL has also placed
an emphasis upon concussion research and improvement of medical practices. With the League
starting a one hundred million dollar concussion initiative in September 2016. Money will be
spent mainly on medical and neuroscience research with a goal of better understanding how
concussions affect the brain, along with improving upon safety procedures and treatment for
Return to Play
The NFL has a return to play policy that is centered upon giving providing players with
the best circumstances for a safe recovery. With the steps listed below being put into place to
allow players to be able to progress through their recovery while being monitored by medical
professionals.
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1. Rest and recovery: Until a player returns to the "baseline level of signs and symptoms and
neurological examination," only limited stretching and balance activities are recommended.
athletic trainer to "determine if there are any recurrent concussion signs or symptoms."
3. Continued aerobic exercise and introduction of strength training: Increased duration and intensity
of aerobic exercise with strength training added. An athletic trainer will supervise to watch for
Legislation
As concussions become a more prevalent issue in sports from little kids playing their first
season of tackle football all the way up to the professional level where findings on long term
impacts are being published and drawing large amounts of attention, the passage of more
advanced legislation is something that is naturally starting to come forward. Most recently
through the Concussion Awareness and Education Act of 2015 which amends the Public
Health Service Act. Now Requiring the CDC to have more oversight in the regulation of
concussions, specifically in the age group of five to twenty-one. Along with making the
collection of the following data mandatory: the demographics of injured individuals, pre-existing
conditions of affected individuals, the use of involved protective equipment, the medical
qualifications of athletic staff diagnosing concussions, along with the cause and severity of the
concussion received by the involved party. This legislation also sets standards for future
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concussion research with an emphasis on research towards the long term effects of concussions.
With the bill gaining its sponsorship from Joyce Beatty a Democrat from Ohio, the bill is
Forty nine out of the fifty states currently have individual laws regarding concussion
regulation in youth sports. With Wyoming being the only state without legislation on the books
although the state is currently in the process of passing laws on the matter ("Concussion
Conclusion
Concussions are one of the biggest injury concerns in sports today from little kids, high
school athletes, the collegiate level, and all the way up into professional sports. With the truth
coming out about what all of the possible side effects are. It is becoming increasingly important
to for all individuals from the coaching staffs to the actual athletes themselves to be informed
about the proper procedures and safety regulations. Along with their being an increased emphasis
upon concussion research. Allowing for the improvement of diagnosis, treatment, and the
equipment that is used to keep athletes safe. Along with actual safety improvements legislation
and court cases are changing the ways that concussions are being viewed. With all of these steps
being followed the chance for increased brain health has a positive outlook for the future.
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References
http://www.aans.org/patient%20information/conditions%20and
%20treatments/concussion.aspx
Associated Press. (2016, October 20). N.F.L.s concussion protocol gets a change.
gets-a-change.html
Bey, T., & Ostick, B. (2009, February). Second impact syndrome. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2672291/
Can just one concussion change the brain [Interview by I. Flatow]. (2013, March 15).
change-the-brain
http://www.brainline.org/content/2008/12/concussion-and-sports.html
Concussion care belongs at the top of every youth sports playbook. (n.d.). Retrieved from
http://www.nsc.org/learn/safety-knowledge/Pages/Sports-Concussions.aspx
http://www.concussiontreatment.com/concussionfacts.html
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Concussion legislation in the USA. (n.d.). Retrieved from
http://www.knowconcussion.org/resource/concussion-legislation-map/
Concussion management and diagnosis best practices. (2016, November 23). Retrieved
from http://www.ncaa.org/sport-science-institute/concussion-management-and-diagnosis-
best-practices
http://www.nationwidechildrens.org/concussions-in-sports
https://www.countable.us/bills/hr1271-114-concussion-awareness-and-education-act-of-
2015
Gessel, L. M., Fields, S. K., Collins, C. L., Dick, R. W., & Comstock, R. D. (2007).
Concussions Among United States High School and Collegiate Athletes. Journal of
Athletic Training, 42(4), 495-503. Retrieved November 9, 2016, from Family Health
Gessel, L. M., Fields, S. K., Collins, C. L., Dick, R. W., & Comstock, R. D. (2007).
Concussions Among United States High School and Collegiate Athletes. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2140075/
https://www.cdc.gov/headsup/providers/return_to_activities.html
McGrath, B. (2015, March 27). Does Football Have a Future? Retrieved from
http://www.newyorker.com/magazine/2011/01/31/does-football-have-a-future
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Midkiff, M. (2016, November 10). Concussion interview with trainers on return to play
Morales, A. (2016, October 06). Ex-Ole Miss, MSU players suing SEC over concussions.
miss/2016/10/06/former-ole-miss-msu-players-suing-ncaa-sec/91658572/
Schnyer, M. F. (n.d.). Farrell and schnyer: Concussions in sports merits urgent attention.
Schnyer-Concussions-in-sports-merits-10811895.php
Scutti, S. (2016, September 14). NFL announces $100 million concussion initiative.
Sports, S. B. (2016, July 14). Judge oks $75M class-action concussions settlement against
football-concussions-lawsuit-ncaa/87097982/
Stites, A. (2016, September 18). Explaining the NFL's concussion protocol. Retrieved
from http://www.sbnation.com/nfl/2016/9/18/12940926/nfl-concussion-protocol-
explained
https://www.bu.edu/cte/about/what-is-cte/
http://concussionfoundation.org/learning-center/what-is-cte
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Grading Rubric for Almost Final Graded Draft
Average
Mechanics, Zero to very few A few errors Several errors Many errors inhibit
Spelling, text
Sentence
Structure, etc
Academic Voice Academic Academic Academic language Paper lacks
language used
language used through most of used for some of academic
paper
throughout paper paper language
informal
throughout
presence
Title, Abstract, All present and All present All present need Missing pieces
to fix several errors
Body, Reference correct needs to fix a few or somewhat
incomplete
errors didnt
quite make it to
15 pages
especially after
big quote
16 = 100 12 = 88 8 = 76 4 = 64
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15 = 97 11 = 85 7 = 73 No submission = no
score
14 = 94 10 = 82 6 = 70
13 = 91 9 = 79 5 = 67
Please do the following for final: Just scroll through and fix what is marked.