Football Tackles Concussion Risk

What's being done to protect football players from concussions and their effects.

Reviewed by Laura J. Martin, MD on January 28, 2013
From the WebMD Archives

When a football player suffers a concussion during a game or in practice, whether they're a pro or a student, it's serious business. And the sport is taking it seriously.

Doctors, coaches, and researchers are focused on the damage concussions can do to football players’ brains as a result of the many tackles they endure.

Research shows that athletes who have repeated concussions are more likely to get long-term brain damage, including a condition known as chronic traumatic encephalopathy (CTE), a brain disease that mimics dementia.

Former NFL players who have had CTE include the late Junior Seau, Chris Henry, and Dave Duerson.

When Concussion Strikes

In a concussion, the brain shakes so forcefully that it hits the inside of the skull. That injures the brain.

Symptoms of a concussion can include:

  • loss of consciousness
  • drowsiness
  • confusion
  • headache
  • nausea or vomiting
  • blurred vision
  • loss of memory of events surrounding the injury.

If a concussion leaves someone unconscious for more than a few minutes, the concussion is clearly serious. But sometimes even seemingly mild concussions can do damage.

"A minor hit on the field can take a long time to recover," says Mark Lovell, PhD, founding director of the University of Pittsburgh Medical Center (UPMC) Sports Medicine Concussion Program.

How many concussions are too many? That may be the wrong question.

"It's not as simple as how many concussions someone's had -- it's total brain trauma" that matters, says Boston University neurosurgery professor Robert Cantu, MD, who is a senior advisor to the NFL's Head, Neck, and Spine Committee.

"Linemen who've had almost no concussions have the majority of cases of chronic traumatic encephalopathy, because on every play they get their brains rattled, trying to block with their head," Cantu says.

NFL's Rules

In 2011, the NFL set rules to determine whether an athlete who’s taken a powerful hit and sustained a concussion will be benched or sent back into the game.

The guidelines include checking the player's symptoms, attention, memory, and balance, starting immediately, on the sidelines.

"It incorporates the most important aspects of a focused exam, so that injury is identified, and athletes with concussion and more serious head and spine injury can be removed from play," says Margot Putukian, MD, chair of the return-to-play subcommittee of the NFL's head, neck, and spine committee.

Hitting Young Players Hard

No athlete should be allowed to participate in sports if he or she is still experiencing symptoms from a concussion, according to the American Academy of Neurology. And before they go back to play, they should first see a doctor who's had proper training to make sure they're ready.

That often doesn't happen, though. Many concussions go unreported. Athletes are often eager to get back in the game. They may think they feel fine, or at least good enough.

"The long-term effects of a few concussions on the young athlete is an incomplete book," Lovell says. "We're just starting to scratch the surface"

"You don’t have to play for a number of years in the NFL to have brain trauma that can cause long-term damage," Cantu says. "You can pick up enough of that trauma just playing in high school and college."

High school athletes who have suffered as few as two concussions may already have the signs of “post-concussion syndrome,” researchers reported in January 2011.

They found that young athletes who had had at least two concussions were more likely to have:

  • Brain symptoms, such as memory problems or feeling mentally "foggy."
  • Physical symptoms, including headaches, problems with balance, or feeling dizzy.
  • Sleep symptoms -- specifically, sleeping either more or less than they normally would.

A major problem for young athletes is that high school and even some college programs may not have the resources to protect their players from concussion.

"At the professional and, to a lesser extent, the collegiate level, everybody's trying to protect these athletes from getting hurt. But at the lower level, it's not managed as well," says Connecticut neurologist Anthony Alessi, MD.

"There's not usually a doctor on the sidelines at a high school football game to evaluate an athlete after a concussion," Lovell says. "And most high school football teams don't have athletic trainers."

Schools often cite cost as the problem.

"Many high schools say they can't afford to have an athletic trainer. I say that means you can't afford to have a program," Alessi says. "If you can't afford to make the program safe, then you should be closing it up."

Show Sources


Robert Cantu, MD, clinical professor of neurosurgery, Boston University School of Medicine; codirector, 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, Inc.

News release, National Football League.

ABC News: "Junior Seau Diagnosed with Disease Caused by Hits to Head: Exclusive."

The New York Times :"Former Bengal Henry Found to Have Had Brain Damage" and "Data Reinforces Dementia Links."

Chicago Tribune: "The Final Days of Dave Duerson."

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."

Boston University Center for the Study of Traumatic Encephalopathy: "NFL Player Dave Duerson Suffered from Advanced CTE."

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