Concussion Prevention: Creating a Safe Sport Culture

Soccer player at the doctors

As a youth sports coach or parent, your actions can create a safe sport culture and can lower an athlete’s chance of getting a concussion or other serious injury.

Young athletes deserve to play sports in a culture that celebrates their hard work, dedication, and teamwork, and in programs that seek to create a safe environment—especially when it comes to concussion.

Young athletes thrive when they:

Have fun playing their sport.
Receive positive messages and praise from their coaches for concussion symptom reporting.
Have parents who talk with them about concussion and model/expect safe play.
Get written instructions from a health care provider on when to return to school and play.
Support their teammates sitting out of play if they have concussion.
Feel comfortable reporting symptoms of a possible concussion to coaches.¹

Enforce the Rules

Enforce the rules of the sport for fair play, safety, and sportsmanship. Ensure athletes avoid unsafe actions such as:

Striking another athlete in the head;
Using their head or helmet to contact another athlete;
Making illegal contacts or checking, tackling, or colliding with an unprotected opponent; and/or
Trying to injure or put another athlete at risk for injury.

Tell athletes you always expect good sportsmanship, both on and off the playing field.

Talk about Concussion Reporting

Talk with athletes about the importance of reporting a concussion.

Some athletes may not report a concussion because they don’t think a concussion is serious. They may also worry about:

Losing their position on the team or during the game.
Jeopardizing their future sports career.
Looking weak.
Letting their teammates down.
What their coach or teammates might think of them.^2,3,4

Get a Concussion Action Plan in Place

Create an action plan that provides information on how to teach athletes ways to lower their chances of getting a concussion. If you think an athlete may have a concussion, you should:

Remove the athlete from play.
Keep an athlete with a possible concussion out of play on the same day of the injury and until cleared by a health care provider. Do not try to judge the severity of the injury yourself. Only a health care provider should assess an athlete for a possible concussion.
Record and share information about the injury, such as how it happened and the athlete’s symptoms, to help a health care provider assess the athlete.
Inform the athlete’s parent(s) or guardian(s) about the possible concussion and refer them to the CDC’s website for concussion information.
Ask for written instructions from the athlete’s health care provider about the steps you should take to help the athlete safely return to play. Before returning to play an athlete should:

Resume their regular school activities.
Not have any symptoms from the injury when doing normal activities.
Have the green-light from their health care provider to begin the return to play process.

Why This Is Important

Athletes May Try to Hide Concussion Symptoms.

As many as 7 in 10 young athletes with a possible concussion report playing with concussion symptoms.⁵
Out of those, 4 in 10 said their coaches were unaware that they had a possible concussion.⁵
As many as 25% of the concussions reported among high school athletes result from aggressive or illegal play.⁶

Young Athletes Are More Likely to Play With a Concussion During a Big Game.

In almost all sports, concussion rates are higher during competitions than in practice.⁷
Athletes may be less likely to tell their coach or athletic trainer about a possible concussion during a championship game or other important event.⁸

Most Sports-Related Concussions Are Caused by Player-to-Player Contact.

Over two-thirds (70%) of concussions among young athletes result from contact with another athlete.⁷
This is followed by player-to-surface contact (17%), such as hitting the ground or other obstacle.⁷

Headache Is Most Commonly Reported Concussion Symptom.

Almost all (94%) high school athletes with a concussion reported having a headache.⁷
Other commonly reported symptoms include:⁷

Dizziness (76%)
Trouble concentrating (55%)
Confusion (45%)
Bothered by light (36%)
Nausea (31%)

Sport Specific:	Prevention Tips:	Why Is this Important?
Baseball	Make sure athletes always wear a batting helmet that fits well and is in good condition. Teach athletes proper fielding techniques and ways to avoid collisions with other athletes. Work with the game or event administrator to remove tripping hazards and ensure that equipment has padding that is in good condition.	About 1 in 4 concussions in high school baseball result from a player from being hit by the pitch (26%).⁷ Over a quarter of concussions (26%) in high school baseball happen when an athlete is fielding a batted ball.
Basketball	Enforce the rules of the sport for fair play, safety, and sportsmanship. Ensure athletes avoid unsafe actions such as: Hitting another athlete in the head; Using their head to contact another athlete; Making illegal contacts or colliding with another athlete; and/or Trying to injure or put another athlete at risk for injury. Work with the game or event administrator to remove tripping hazards and ensure that equipment (such as goalposts and walls), have padding that is in good condition	Girls have higher rates of concussion than boys in high school basketball.⁷ Almost two-thirds (65%) of concussions among boys who play high school basketball resulted from contact with another athlete.⁷ Half (51%) of concussions among girls who play high school basketball resulted from contact with another athlete.⁷
Cheerleading	Ensure cheerleaders have appropriate supervision during practices and a designated and safe practice facility. Limit the amount of stunts during practices. When stunting is performed, always use spotters and make sure the surface is soft and in good condition. Teach safe stunting techniques and do not allow cheerleaders to attempt new or difficult stunts without proper instruction and a coach on hand.	Most concussions in high school cheerleading happen during practice.⁷ Almost all (91%) concussions among high school cheerleaders are associated with stunts (i.e. toss or lift).⁷ Almost half (45%) of high school cheerleaders who had a concussion as result of a stunt did not have a spotter (teammate or coach).⁷
Field Hockey	Enforce the rules of the sport for fair play, safety, and sportsmanship. Ensure athletes avoid unsafe actions such as: Making illegal contacts or dangerous stick play (e.g., swinging, checking) around the head and/or Trying to injure or put another athlete at risk for injury. Work with the game or event administrator to remove tripping hazards and ensure that equipment, such as goalposts, have padding that is in good condition.	Six out of 10 (61%) concussions in field hockey happen as a result of player-equipment contact (i.e. contact with a stick or ball).⁷ Activities most commonly resulting in concussion are:⁷ Defending (37%) Chasing a loose ball (12%)
Football	Teach athletes proper tackling and blocking techniques and ways to avoid hits to the head. Limit the amount of contact during practices. This may include:⁹ No full speed head-on blocking or tackling drills in which the players line up more than 3 yards apart. Limiting the amount of practice time that includes scrimmages or full-speed drills.⁹ The American Academy of Pediatrics recommends:¹⁰ Expanding the availability of non-contact football programs. Having skilled athletic trainers available at games and practices. Keep a close eye on athletes during running plays, especially an athlete in the running back position. Enforce the rules of the sport for fair play, safety, and sportsmanship. Ensure athletes avoid unsafe actions such as: Hitting another athlete in the head; Using their helmet to contact another athlete (helmet-to-helmet or helmet-to-body contact); Making illegal contacts, tackling, or colliding with an unprotected opponent; and/or Trying to injure or put another athlete at risk for injury. Make sure athletes always wear a helmet that fits well and is in good condition. Work with the game or event administrator to remove tripping hazards and ensure equipment, such as goalposts, have padding that is in good condition.	Almost half (49%) of concussions in high school football happen during running plays.⁷ Tackling is responsible for almost two-thirds (63%) of concussions in high school football.⁷ Linebackers sustain over half (59%) of all concussions among high school football defensive players.⁷ Running backs sustain 46% of concussions among high school football offensive players.⁷
Ice Hockey	Limit the amount of contact during practices. This may include: Limiting the amount of practice time that includes scrimmages or full-speed drills. The American Academy of Pediatrics recommends:¹¹ Expanding the availability of non-contact hockey programs. Limiting body checking in competition to athletes age 15 and over and to elite levels of youth ice hockey. Teaching body-checking skills in practices only for athletes age 13 years and over who are geared to elite participation. Keep a close eye on athletes in the wing position—who are at increased risk for concussion. Enforce the rules of the sport for fair play, safety, and sportsmanship. Ensure athletes avoid unsafe actions such as: Hitting another athlete in the head; Using their helmet to contact another athlete (helmet-to-helmet or helmet-to-body contact); Making illegal contacts or checking or colliding with an unprotected opponent; and/or Trying to injure or put another athlete at risk for injury. Make sure athletes always wear a helmet that fits well and is in good condition. Work with the game or event administrator to remove tripping hazards and ensure that equipment has padding that is in good condition.	Concussions are 13 times more likely to happen during competitions versus practice in high school ice hockey.⁷ Almost two-thirds (64%) of concussions in high school ice hockey resulted from contact with another athlete.⁷ About 1 in 3 concussions in high school ice hockey (30%) result from being checked.⁷ Half of concussions in high school ice hockey are sustained by athletes in the wing position.⁷
Lacrosse	Boys: Limit the amount of contact during practices. This may include: Limiting the amount of practice time that includes scrimmages or full-speed drills. Teach athletes proper checking techniques and ways to avoid hits to the head. Keep a close eye on athletes in positions that are at increased risk for concussion to help you spot a potential concussion. Enforce the rules of the sport for fair play, safety, and sportsmanship. Ensure athletes avoid unsafe actions such as: Hitting another athlete in the head; Using their helmet to contact another athlete (helmet-to-helmet or helmet-to-body contact); Making illegal contacts or checking or colliding with an unprotected opponent; and/or Trying to injure or put another athlete at risk for injury. Make sure athletes always wear a helmet that fits well and is in good condition. Work with the game or event administrator to remove tripping hazards and ensure that equipment has padding that is in good condition. Girls: Enforce the rules of the sport for fair play, safety, and sportsmanship. Ensure athletes avoid unsafe actions such as: Making illegal contacts or dangerous stick play (e.g., swinging, checking) around the head and/or Trying to injure or put another athlete at risk for injury. Work with the game or event administrator to remove tripping hazards and ensure that equipment, such as goalposts, have padding that is in good condition.	About 3 out of 4 concussions (77%) among boys who play high school lacrosse occurred as a result from contact with another athlete.⁷ Activities commonly associated with concussion among boys who play high school lacrosse are: Being body checked (18%) Chasing a loose ball (14%) Body checking (12%) Defending (12%) Nearly half (48%) of concussions among boys who play high school lacrosse were sustained by midfielders.⁷ The most common cause of concussions among girls who play high school lacrosse is player-crosse/stick contact (42%).⁷ Activities commonly associated with concussion among girls who play high school lacrosse are:⁷ Defending (17%) Ball handling/cradling (15%)
Soccer	Follow US Soccer recommendations: No heading for any athletes age 10 and under. Limit heading only to practices for athletes ages 11 to 13. Teach athletes ways to lower the chances of getting a concussion, including ways to avoid collisions with other athletes. Enforce the rules of the sport for fair play, safety, and sportsmanship. Ensure athletes avoid unsafe actions such as: Hitting another athlete in the head; Using their head to contact another athlete; Making illegal contacts or colliding with another athlete; and/or Trying to injure or put another athlete at risk for injury. Work with the game or event administrator to remove tripping hazards and ensure that equipment, such as goalposts, have padding that is in good condition.	Girls have higher rates of concussion than boys in high school soccer.⁷ Concussions in high school soccer most commonly occur when an athlete is heading the ball.⁷ About 1 in 3 concussions among girls happens during heading (31%). About 1 in 4 concussions among boys happens during heading (28%). Concussions sustained while heading the ball most commonly result from:⁷ Player-to-player contact (74% for boys and 58% for girls) Player-to-equipment contact (such as contact with the ball or goalpost) (13% for boys and 35% for girls)
Softball	Teach athletes proper fielding techniques and ways to avoid collisions with other athletes. Make sure athletes always wear a batting helmet that fits well and is in good condition. Work with the game or event administrator to remove tripping hazards and ensure that equipment has padding that is in good condition.	Over a quarter of concussions (28%) happened when fielding a batted ball.⁷ Only 5% of concussions resulted from being hit by a pitch.⁷
Volleyball	Teach athletes proper diving and digging techniques and ways to avoid hits to the head. Keep a close eye on athletes in positions that are at increased risk for concussion. Work with the game or event administrator to remove tripping hazards and ensure that equipment has padding that is in good condition.	In girls volleyball the outside hitter and setter positions are the most likely to get a concussion (52%).⁷ Almost 40% (39%) of concussions among girls who play high school volleyball happen when an athlete is diving for the ball. This is followed by 25% resulting from player-teammate contact.⁷ Activities commonly associated with concussion in girls volleyball are:⁷ Digging (42%) Passing (16%)
Wrestling	Teach athletes proper takedown techniques and ways to avoid hits to the head. Enforce the rules of the sport for fair play, safety, and sportsmanship. Ensure athletes avoid unsafe actions such as: Hitting another athlete in the head; Making illegal contacts; and/or Trying to injure or put another athlete at risk for injury.	Takedowns are the most common cause of concussion in wrestling (59% of concussions).⁷

References

Centers for Disease Control and Prevention. (2015). CONCUSSION AT PLAY: Opportunities to Reshape the Culture Around Concussion. Atlanta, GA: U.S. Department of Health and Human Services.
Kerr ZY, Register-Mihalik JK, Marshall SW, Evenson KR, Mihalik JP, Guskiewicz KM (2014). Disclosure and non-disclosure of concussion and concussion symptoms in athletes: Review and application of the socio-ecological framework. Brain Inj. 2014;28(8):1009-21. 4
Register-Mihalik JK, Guskiewicz KM, McLeod TC, Linnan LA, Mueller FO, Marshall SW. (2013). Knowledge, attitude, and concussion-reporting behaviors among high school athletes: A preliminary study. J Athl Train, July 12, 2013.
Chrisman, S. P., Quitiquit, C., Rivara, F. P. (2013). Qualitative Study of Barriers to Concussive Symptom Reporting in High School Athletics. J Adolesc Health. March, 2013, 52(3): 330-335.
Rivara FP, Schiff MA, Chrisman SP, Chung SK, Ellenbogen RG, Herring SA. (2014). The effect of coach education on reporting of concussions among high school athletes after passage of a concussion law. Amer J Sports Med, May, 2014, 42(5):1197-1203.
Collins CL, Fields SK, Comstock RD. (2008). When the rules of the game are broken: What proportion of high school sports-related injuries are related to illegal activity? Inj Prev, 14(1):34-38.
Marar M, McIlvain N, Fields S, Comstock RD. Epidemiology of Concussions Among United States High School Athletes in 20 Sports. Amer J Sports Med, April 2012, 40(4):747-755.
Bramley H, Patrick K, Lehman E, Silvis M. (2012). High school soccer players with concussion education are more likely to notify their coach of a suspected concussion. (2012).Clin Pediatr (Phila), 2012 April, 51(4):332-336.
Kerr ZY, Yeargin S, Valovich McLeod TC, Nittoli VC, Mensch J, Dodge T, Hayden R, Dompier TP (2015). Comprehensive Coach Education and Practice Contact Restriction Guidelines Result in Lower Injury Rates in Youth American Football. Orthopaedic Journal of Sports Medicine, 3(7):1-8.
American Academy of Pediatrics. Tackling in Youth Football. Pediatrics. 2015 Nov;136(5).
American Academy of Pediatrics. Reducing injury risk from body checking in boys' youth ice hockey. Pediatrics. 2014 Jun;133(6):1151-7.