Football Concussions: What to Do

How concussions are changing football, from games to practices for pro athletes, college players, and teen athletes.

Reviewed by Laura J. Martin, MD on March 16, 2011
From the WebMD Archives

Concussions make headlines when they affect NFL players, and there is growing awareness that they can also affect teen athletes.

Every high school and college football program -- as well as those for other high-contact sports -- should have a concussion management program, says Mark Lovell, PhD, who founded the University of Pittsburgh Medical Center's Sports Medicine Concussion Program.

Among his recommendations:

Put people on the field who understand the injury. This means doctors trained for this task and a certified athletic trainer. High school teams should call local neurologists to see if they will contribute their time, suggests Connecticut neurologist Anthony Alessi, MD. "Even if they charge, they're the cheapest thing you're going to pay for compared to hospital visits, scans, and EEGs," he says.

Use a standardized test to determine if a player is ready to return. "Athletes will tell you they're fine. Kids think they're invincible," Lovell says. If all you're doing is asking them whether their headache's gone, you're letting a teenager manage his own brain injury." Concussion tests include the King-Devick rapid sideline screening test, developed at the University of Pennsylvania, the Headminder Concussion Resolution Index, Australia's Concussion Sentinel, and ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing, which Lovell developed. Lovell is now CEO of ImPACT Applications.

Ease back into play. When the player is ready to return and has passed the tests to do so, they shouldn't go all-out right away. Instead, they should go through a program that gradually prepares them to play. "Just because they don't have a headache, it doesn't mean you can go ahead and put them back on the field," Alessi says. "Your athletic trainer needs to put together a program -- first having them walk at a certain pace, then run, then do wind sprints, bike, and lift weights -- to see if the player can do those things without a headache or other symptoms."

Monitor players who've had concussions long-term. "Especially for those who've had multiple concussions, be alert for signs that they're getting injured more easily and with less provocation, or that symptoms are lasting longer and are more severe," Lovell says. This may be a sign of chronic injury.

Several states have passed concussion legislation targeting student athletes. Such measures generally require coaches to temporarily remove student-athletes suspected of having a concussion from competition. Those players must have a doctor's note before returning to play.

What's considered acceptable in games and during practice also matters.

"There shouldn’t be any practices where kids are purposely encouraged to hit each other with their heads," says Robert Cantu, MD, author of Concussions and Our Kids. "There are drills used right now… the old-school toughness drills that are just not good."

Cantu also recommends that less contact and hitting be done in practices and scrimmages.

"This kind of attention is going to other sports that also have a high incidence of head injury," Cantu says. "That’s all good."

Show Sources


Robert Cantu, MD, clinical professor of neurosurgery, Boston University School of Medicine; co-director, Neurological Sports Injury Center, Brigham and Women’s Hospital, Boston; author, Concussions and Our Kids.

Anthony Alessi, MD, associate clinical professor of neurology, University of Connecticut.

Mark Lovell, PhD, founding director, University of Pittsburgh Medical Center (UPMC) Sports Medicine Concussion Program, Pittsburgh; CEO, ImPACT Applications.

News release, National Football League.

American College of Sports Medicine: "Concussions: ACSM Issues Recommendations for Diagnosis, Treatment and Prevention."

Schatz, P. Neurosurgery, Jan. 6, 2011.

EMS Responder: "Concussion Care for Teen Athletes."

Yard, E. Brain Injury; October 2009; vol 23: pp 888-898. "NFL Study Finds More Dementia Among Retired Football Players."

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