Introduction

In many sports, physical contact is a fundamental aspect of performance, meaning that contact injuries are an unfortunate risk that comes with participation. Whilst contact injuries are inevitable in many sports, governing bodies have taken steps in recent years to minimise the risk of injuries that have potential to cause long term health implications, with particular attention being paid to head injuries like concussions. Concussions are defined as a type of mild traumatic brain injury and are most commonly sustained in sport when an athlete suffers direct trauma to the head or experiences a sudden change in speed causing a whiplash like effect.¹ The potential effects of a concussion can vary from mild to severe, ranging from headaches and dizziness to movement disorders and increased risk of cognitive disease.² The following article explores concussions in sport and what sporting governing bodies are doing to protect the welfare of their athletes. 

What is a Concussion? 

A concussion is defined as a mild traumatic brain injury that can negatively affect the way our brain functions.¹ A concussion occurs when your brain rapidly moves forwards or backwards and crashes against the skull, causing it to become stretched and damaged.¹ Concussions are usually caused by either a direct blow to the head or any impact to the body that causes your head to jolt forwards or backwards. Concussions are relatively common in sport, affecting approximately 5-10% of athletes throughout a sports season. Concussions are more likely in sports that involve physical contact, with sports like boxing, mixed martial arts, American football, football, rugby, and hockey recording the highest rates of concussions.³ Common causes of concussions in sport include collisions with opponents or objects, heavy falls, and incorrect technique. 

Symptoms 

The symptoms of a concussion can range from mild to severe, with some being hard to spot. Whilst most head injuries are not serious, you should always seek medical attention as a precaution if you experience any of the following symptoms after suffering an impact to the head or body:

• Headache
• Dizziness
• Nausea and vomiting  
• Memory loss 
• Concentration issues 
• Slurred speech
• Loss of balance  

Effects of a Concussion 

Most concussions will only temporarily affect the way your brain functions, with most symptoms taking between 14-21 days to subside. As well as experiencing the above symptoms, you may experience some of the following adverse effects on your daily life.² 

• Trouble concentrating 
• Feeling dizzy, lightheaded, and sick 
• Experiencing mood swings 
• Feeling confused or easily overwhelmed 
• Difficulty sleeping 
• Feeling tired and drowsy 

In more severe cases, such as a hard blow to the head or repeated head trauma over numerous years, the effects of a concussion can be much more permanent and debilitating. Below are some of the long term health implications associated with concussions.⁴ 

• Persistent post-concussion syndrome 
• Increased risk of Alzheimer’s, Parkison’s disease and Dementia
• Impaired cognitive skills e.g. memory issues 
• Headaches    
• Depression and anxiety 
• Permanent behavioural changes 

Prevention Strategies 

With research growing on the association between repeated concussions and severe long-term health implications, sporting governing bodies have implemented various measures designed to help protect the welfare of their athletes. The following section explores some of the main strategies spearheading sports efforts to reduce concussions. 

Education and Awareness 

Raising understanding and awareness plays a vital role in the prevention of concussions in both grass roots and elite level sport. Sporting governing bodies such as The Football Association (FA), National Football Association (NFL), England Hockey, and the Rugby Football Union (RFU) have all developed educational courses designed to teach athletes, coaches, officials, and parents how to recognize, report, and manage concussions, ensuring symptoms do not go ignored. These courses also educate participants on the governing bodies concussion protocols, ensuring that all those involved in the sport know exactly how to act in the event of a suspected concussion, meaning each incident is dealt with a consistent and evidence based-approach. 

Rule Changes 

Numerous sports have adapted and strongly enforced new rules designed to reduce concussion rates, specifically aiming to modify, reduce, or completely eliminate certain actions or plays that carry a higher risk of concussions. Below are a few examples of rules that have been enforced to help reduce concussions in various sports 

• Introduction of helmets and protective padding in sports like baseball, American football and cycling
• Introduction of the fair catch rule in NFL
• Introduction of a lower legal tackle height in rugby 
• Outlawing of checks to the head in hockey 
• Boxing bouts reduced from 15 to 12 rounds 

The introduction of these rules has proved successful across many sports, with research identifying a 15-50% drop in concussion rates in certain sports after specific rule changes, showing that introducing rules to ensure the welfare of athletes can be extremely effective.^5,6

Technique Training

Ensuring athletes utilise the correct technique when competing can greatly reduce their risk of suffering a concussion. Regularly practicing safe techniques in training has proven to be an effective tool to help reduce concussions in sport.⁷ In many sports, athletes utilise protective equipment in training such as headguards, gum shields, tackle pads, and hit shields to practise actions such as tackling and safe fall techniques before engaging in full contact competition. Regularly practising technique, even at elite levels, allows safe techniques to be practised and reinforced in the athletes mind, significantly reducing their risk of sustaining a concussion as a result of incorrect technique. 

Medical Assessment and Management

The way in which suspected concussions are assessed and managed has changed greatly in sport in recent decades. In the immediate response to a suspected concussion, tools like the SCAT-5 (Sport Concussion Assessment Tool) have been developed, allowing a thorough and accurate assessment of an athlete to be made before determining if they can continue competing, preventing further more severe damage. In the event an athlete has sustained a concussion, many sports have adopted much stricter rulings on when a player can return to training and competitive performance,  with many sports requiring 1-3 weeks of recovery time before the athlete can return, ensuring an athlete does not return to competition before they have fully recovered. Many sporting governing bodies have also enforced mandatory pre-season cognitive assessments. Pre-season cognitive tests allow for a baseline assessment to be made and compared against later in the season should an athlete sustain a head injury, allowing changes in the athlete’s cognitive state to be easily identified. 

Advancements in Equipment 

Sports scientists and researchers are constantly on the search for ways to enhance sports, including the safety of the equipment used. Advancements in safety equipment have arguably been at the forefront of sports efforts to reduce the risk of concussions, as well as many other injuries. Below are some of the most common examples of equipment in sport that have proven effective in bringing down concussion rates in sport.

• Helmets - Helmets are one of the most common pieces of equipment used to protect athletes from head injuries. Helmets are designed to absorb the impact from strong blows to the head or collisions with hard surfaces, helping protect the brain. In recent years, advancements in technology have allowed for impact detectors to be fitted inside helmets, allowing medical professionals to conduct an immediate assessment of an athlete’s concussion risk after a collision. Wearing a helmet can significantly reduce an athlete’s risk of suffering a concussion, helping reduce concussions by as much as 31% when worn in certain sports⁸ 
• Mouthguards - Research indicates that wearing a custom fitted mouthguard can reduce an athlete’s risk of concussion. Despite mainly functioning as a tool to protect against dental and jaw injuries, custom mouthguards may help absorb some of the impact from a collision or fall, helping protect the brain
• Protective Body Padding - Protective padding like shoulder pads and chest protectors are commonly worn in American football and mixed martial arts to protect against both upper body injuries and head injuries. Protective padding helps absorb the impact of a direct impact to the body, preventing the whiplash like effect from occurring as a result of the sudden change in direction, therefore, lowering the risk of sustaining a concussion
• Neck Collars - Neck collars are growing in popularity in sports like American football. Neck collars function by applying light pressure against the jugular vein, increasing blood flow towards the brain. Increased blood to the brain helps reduce the amount in which the brain can move during a collision, known as ‘brain slosh’, therefore helping prevent the brain from colliding with the skull and causing a concussion

Summary 

As research grows on the potential long term dangers of suffering repeated concussions, sporting governing bodies have stepped up their efforts to minimise the risk of concussions in their sport, with preventing measures such as educational courses, concussion protocols, and rule changes spearheading sports efforts to reduce concussion risk. Concussions are more frequent than some would expect in sport, affecting between 5-10% of athletes throughout a sporting season. Despite this, it is extremely easy to overlook some of the symptoms of a concussion, meaning some may go unnoticed. To help raise your own understanding of concussions, how you can prevent them, and how they should be managed, consider taking time to read your sports concussion protocols or even signing up for a concussion course run by your sports governing body.