on sports medicine clinicians to prematurely return collegiate athletes to play
after concussion

Kroshus E, Baugh CM, Daneshvar DH, Stamm JM,
Laursen RM, Austin SB. J Athl Train 2015; 50(6) ahead of print.

Take Home Message: More
than half of the sports medicine staff experience pressure from coaches and
athletes to release athletes prematurely to play following a concussion.

are sometimes referred to as the “invisible injury” for many reasons (there is
no structural damage on imaging reports and small deficits are not always
easily detected with the current assessment tools). This creates an environment,
where the athlete or coach may believe that the concussed athlete is ready to
return to play and may pressure the medical professional to return the athlete
to play prematurely. Therefore, the authors utilized a web-based survey for
clinicians who provide care to US collegiate sports teams to quantify the
extent they experienced pressure to prematurely clear athletes for
participation after a concussion. Seven hundred and eighty-nine athletic
trainers and 111 team physicians (from 530 institutions) completed the survey.
The survey was composed of 2 main types of questions. First, participants answered
demographic type questions (their sex, position in the sports medicine team,
number of years working on a sports medicine team, NCAA division, and sex/sport
of the team or teams for which they provide care, and whether the heads of
their department reported to the athletic department, medical institution, or
another entity). The authors also assessed the extent to which a clinician agreed
with statements about having experienced pressure from clinicians, coaches, or the
athletes themselves to prematurely release an athlete following a concussion. Across
all respondents 64% agreed that they experienced pressure from athletes to
clear them following a concussion. Fifty-four percent of respondents agreed
that they had pressure from coaches and 6.6% agreed they had pressure from other
clinicians. Athletic trainers (55%) were more likely than physicians (41%) to
experience pressure from coaches. Respondents reported greater pressure from
coaches when their departments were under the athletic department’s supervision
(54%) rather than a medical institution (40%). Athletic trainers reported less
pressure from athletes and coaches in Division III compared with Division I.
Female athletic trainers (61%) reported greater pressure from coaches than
males (49%), and Female physicians reported greater pressure from other
physicians than males.

authors exemplified that there is pressure on medical professionals to return
an athlete to play prematurely. Over half of the clinicians reported
experiencing this pressure. Though, the frequency of the pressure and the
number of times an athlete was released prematurely is unknown, this is still an
alarming response. Another resonating finding was that medical professionals
that report to athletic departments experience greater pressure from coaches
than those who work under a medical institution, which suggest that a sports
medicine team functioning under a medical institution seems to be in the better
interest of the patient. Furthermore, it was distressing to see that out of the
530 institutions only 63 institutions were reported to be functioning under the
medical supervisory structure. Another school characteristic such as division
of school seemed to be strongly predictive, where respondents at a Division I reported
the most pressure. This may be due to higher level of competition, stronger
athletic identity, and desire to be part of a team. Additionally, female
athletic trainers reported greater pressure from coaches compared with males,
which suggests coaches feel females are less qualified or more easily
intimidated compared to males. This study illustrates the importance for
identifying factors associated with variability of pressure on sports medicine
professionals to release concussed patients prematurely, and accentuates the
need for open communication, and more concussion education among supervisors,
coaches, and athletes. Furthermore, in a setting where coaches and athletes are
often focused on today it is vital for sports medicine clinicians to be
thinking about our patient’s long-term health and safety.

Questions for Discussion:
Do you work under a medical supervisory system? Do you feel pressure from other
sources not investigated by the authors? How do you handle pressure to return
an athlete to play early?

by: Jane McDevitt, PhD
by: Jeff Driban


Kroshus E, Baugh CM, Daneshvar DH, Stamm JM, Laursen RM, & Austin SB (2015). Pressure on Sports Medicine Clinicians to Prematurely Return Collegiate Athletes to Play After Concussion. Journal of athletic training PMID: 26207440