Sports-Related Head Injuries

Understanding the Role of the Coach and Team Trainer in Protecting Athletes and Educating Families About Sports-Related Head Injuries

High school athletic programs that engage in competitive contact sports, such as football, basketball, hockey, soccer and others, should have an athletic trainer who is knowledgeable about common aspects of sports injuries. These individuals receive specialized training and education and often possess a Master’s degree. The trainer serves as the consultant to the coach and athletes’ families on critical health issues, such as whether a student is fit to return to play following a concussive head injury.

High school athletes are generally minors and depend on the guidance of their coaches and families to protect their long-term health. Coaches, school systems and athletic programs have a responsibility to employ a minimum standard of care to assure that important decisions, such as return to play following a head injury, result from an assessment that assures basic protection for the athlete. Many teams do not have a team physician altogether and/or on the field during play, and some schools do not have an athletic trainer with proper expertise to make these types of determinations. Some smaller athletic programs may place the responsibility on the parent to find a competent doctor.

Some small or underfunded athletic programs have no trainer or team doctor. In these resource poor systems where no team doctor or athletic trainer is available to assist with decision making, the coach on the playing field may assume responsibility for that decision. In some instances, a referee may decide that a player is not able to continue playing. Teenage athletes often lack the level of knowledge and sophistication to make a properly informed decision for themselves. Families should inquire about whether a coach has learned about concussions and has basic expertise to make informed safe decisions.

Each team and school system may be different in its approach to this problem. The critical element for the family should include whether or not the decision maker on the field understands concussive head injury and has a process by which he or she decides whether a student is safe for return to play. Families should beware of any situation where the coaching staff minimizes or denies the importance of understanding concussive head injuries and having a well-designed approach for dealing with the issue.

In addition, families must decide whether their primary care physician has the background and expertise to make an informed decision about safety and playing. Primary care doctors have a range of abilities in assessing concussive head injury and making informed decisions about return to play. Many primary care doctors have developed expertise in the field of sports medicine through ongoing education and coursework. Others may have very limited understanding about the mechanisms and consequences of concussive head injury. Most emergency room doctors are familiar with this medical problem. Most neurologists as well as sports medicine specialists have the expertise in this area. Student athletes participating in contact sports who have suffered multiple concussive head injuries should probably be evaluated by either a sports specialist or a neurologist to craft a strategy for prevention and assessment of continued play.

Contributed by Richard E. Powers, M.D., chairman of the Alzheimer’s Foundation of America’s Medical Advisory Board and chief of the Bureau of Geriatric Psychiatry, Department of Mental Health and Mental Retardation for the State of Alabama

Checklist : Important Concerns for Protecting Your Family Member’s Brain During Contact Sports

1. Does the team have a team doctor trained in sport concussion?    
2. Is the team doctor familiar with guidelines for playing following concussive injury?    
3. Do coaches follow national published recommendations on playing injured athletes?    
4. Is your athlete free from a past history of traumatic injury or incidents of concussive head injury?    
5. Does your athlete understand the importance of telling the coach about a head injury during play?    
6. Does the team have an environment that encourages athletes to report head injury?    
7. Does the team have a standard medical protocol for evaluating head injuries and concussions?    
8. Are athletes protected from coaching retaliation for reporting injuries?    
9. Do the team boosters and school administration support a brain safety program?    
10. Does the school or athletic director have a written policy and protocols on dealing with head injured athletes?    
11. Does the team have a conditioning program to improve strength and agility to protect the neck and head?    
12. Does the administration require a preseason concussion educational program or distribute educational materials like the “Heads Up Program” produced by the Centers for Disease Control?    

More “Yes” checks suggest more safeguards may be in place to protect a player. Absence of these protections does not mean that the athletic program is unsafe, but should raise concerns for parents and spark conversation with school officials.

Contributed by Richard E. Powers, M.D., chairman of the Alzheimer’s Foundation of America’s Medical Advisory Board and chief of the Bureau of Geriatric Psychiatry, Department of Mental Health and Mental Retardation for the State of Alabama

Read feature article in care ADvantage magazine, “Head Injury and Football: A Changing Playing Field

Read a blog about contact sports and brain injury {click here}

Additional resources

American Academy of Neurology Position Statement on Sports Concussion

Centers for Disease Control and Prevention



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