Sports Medicine Research: In the Lab & In the Field: Coaches Influence the Reporting of Concussive Symptoms Among High School Athletics (Sports Med Res)


Wednesday, April 10, 2013

Coaches Influence the Reporting of Concussive Symptoms Among High School Athletics

Qualitative Study of Barriers to Concussive Symptoms Reporting in Higher School Athletics

Chrisman SP, Quitiquit C, and Rivara FP. J Adolesc Health. 2013; 52:330-335.

Take Home Message: Despite understanding the long-term dangers of sustaining a concussion high school athletes show little evidence that they would remove themselves from athletic participation.

Various educational and procedural methods have been put into place to protect student-athletes who have incurred a concussion from sustaining a second. Despite this effort, between 20 and 60% of athletes do not report sustaining a concussion. A deeper understanding of why there is a lack of reporting of concussive symptoms would allow clinicians to effectively educate coaches and athletes, improving overall patient care. Therefore, Chrisman and colleagues completed a qualitative study to determine the barriers to reporting concussive symptoms among varsity high school athletes. The authors conducted focus groups with 50 high school, varsity athletes (19 = football, 20 = girls soccer, 11 = boys soccer). During the focus groups, investigators began with questions pertaining to how the athletes decided to stop playing when injured. Then they gave the athletes 4 hypothetical scenarios of collisions during athletic activity and then asked if they would continue to play. Investigators used the phrase “experiencing symptoms” rather than the terms “concussion” or “concussive symptoms” to blind the athletes from knowing what injury was being assessed. The major themes which emerged from the meetings were, “athletes know concussions are dangerous,” “most athletes would still play with concussive symptoms,” “it’s hard to tell if you are injured,” “you’re supposed to play injured,” and “the coach matters.” Interestingly, these themes illustrate that while athletes understand the dangers of concussions and often recognize the symptoms they will go to lengths to keep playing. This includes withholding symptoms and knowingly placing themselves in a dangerous situation. Ultimately, it appears that fear of letting the team down and feedback from the athlete’s coach is key. This is particularly evident in the theme that athletes are “supposed to play injured.” This mentality can be directly attributed to, and influenced by the coach, which the respondents alluded to by suggesting “the coaches’ mentality matters.”

Overall this qualitative study demonstrated that despite a number of barriers to reporting concussive symptoms, athletes are keenly aware of the signs and symptoms that indicate a concussion as well as the consequences of concussions. Despite understanding and being able to identify concussion symptoms most athletes reported that they would continue to play. The reasoning behind ignoring, or withholding symptoms mainly hearkened back to social factors of sport such as “letting your team down” or feeling like “you’re supposed to play injured.” Many athletes also reported wanting to “look like a solider” or avoid being viewed as a “wuss” or feeling “embarrassed.” Ultimately, though many of these feelings stemmed from the attitude of the coach. In a few cases, athletes who were more accepting of reporting concussive symptoms attributed this to the coach being positive regarding the reporting of concussive symptoms. This suggests that while the stigma that athletes should “suck it up” remains, this can be influenced by the coach and coaching staff. While current laws and programs have focused on educating a wide range of those involved in athletics, perhaps the key to truly changing the mindset that athletes should “play through it” lays in the specialized education of the coaches given their amount of influence over the athletes. Rather than just educating coaches on symptoms, future programs should educate coaches not only on the importance of symptoms reporting but how to positively encourage their athletes to report these symptoms. Tell us what you have found. Do you believe that your athletes are comfortable with reporting the symptoms of a concussion? If so, do the coaches of these athletes encourage this reporting in a positive manner?

Written by: Kyle Harris
Reviewed by:  Jeffrey Driban

Related Posts:

Chrisman SP, Quitiquit C, & Rivara FP (2013). Qualitative study of barriers to concussive symptom reporting in high school athletics. The Journal of Adolescent Health, 52 (3), 330-335000 PMID: 23427783


Laura Marley ATC said...

While concussion awareness and management has increased as a result of research, a new issue has surfaced as athletes are now deciding to withhold reporting symptoms in order to continue sports participation. It was interesting to read why high school athletes are choosing to place themselves in dangerous situations after sustaining possible concussions. Efforts to educate players, parents, and coaches on the dangers of concussions have clearly done a great job, but now athletic trainers and clinicians are facing circumstances where concussion symptoms are not being reported by players which is, in turn, increasing the risk of more serious complications. Now that unspoken pressures from coaches and players have been identified as the cause, I believe concussion education programs for coaches will begin to add a new component discussing the importance that their attitudes have on athletes' safety. I have heard of instances where coaches tell their players to lie to athletic trainers during concussion evaluations in order to avoid removal from play. This absolutely has to stop. Coaches need to realize how important and serious their role is . Coaching staff and athletic trainers need to continue to work as a team and respect each other while prioritizing the safety of athletes.

Kyle Harris said...


This withholding of information, or worse encouragement to withhold is a terrible issue facing many clinicians today. I think you hit the nail on the head so to speak with your comment on the need for coaching staff and clinicians to work together as a team. I try very hard from the first day interacting with a new coach to show them that I want their players on the field as much as they do. I also try to impress on them that by not working together (in this case encouraging an athlete to withhold information) could really negatively impact the teams success more than if we worked together and could maybe resolve the issue. This idea often gets their attention as they see my intention to take care of an issue and safely return the athlete to play as quickly as possible. Has this been an issue you have dealt with? Are you still dealing with it or has it been resolved, and if so how?

Stephanie Michel said...

Athletes are totally uncomfortable with reporting symptoms, especially of a head injury. As the article said, they do not want to seem like they are weak because they are removing themselves from competition. If the player is a key part to the teams success, I feel like they encourage the athlete to just rest for a few minutes after a blow to the head, rather than seeking treatment. Concussion guidelines have become so strict, that once athletes feel better, they think they can rejoin the competition. I don't think the general public knows enough about the long term effects of concussions, like CTE. If more people knew about pathologies like that, I feel like athletes and coaches would be more likely to report head injuries.

Becca Burkhart said...

I thought that this article was very interesting being an athlete. Coaches have a big impact on the athletes life during the season and athletes take ques from their coaches. I think it would be beneficial not only to educate coaches on concussions, but also on having a positive attitude. The attitude that athletes have about not wanting to be a wuss I think comes from youth training. Even when I was younger we were taught that going down on the field or coming out of the game makes you weak. I think youth athletes also need to be taught that it is okay to be hurt and that head injuries can be lead to serious problems later in life if they are not dealt with.

Brittany Cavacloglou said...

I believe coaches should be required to be educated on concussions and their symptoms to even be allowed to coach. Athletes look up to their coaches and view them as role models. Coaches should express to their athletes that they need to report when they feel injured and it is okay to be taken out of play due to an injury. Coaches should also let their athletes know that being injured doesn’t make them weak and they don’t need to play through the game if they are hurt. If athletes feel comfortable relaying this message to their coaches, it could eliminate long term problems.

Jess Schlesman said...

I found this article to be interesting because what is said is very true. I have played sports for many years and have witnessed coaches promoting the "suck it up" type attitude. Especially if an athlete is a key contributor to the team, the coach seems to put their health second to the game. As awful as this sounds, it is very true. I believe athlete's are afraid to admit to their coaches they are injured because they are afraid of losing playing time, or don't want to seem weak. I agree with Brittany in that coaches should be required to be educated and tested on concussions before receiving a license to coach.

Marisa Rizzo said...

I also found this article very interesting! I have played sports my whole life and have seen the coach that gets mad when someone is injured so the following player doesn't tell anyone because they don't want to disappoint the coach. I hope that by educating coaches and staff will help them understand the danger of concussions and not make their athletes feel scared to tell when something is wrong. Having a coach that knows injuries will really help athletes be able to communicate with them better.

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