Concussion in High School Sports
(Information adapted from the CDC's TBI Coaches Guide)
concussion is a brain injury.
concussions are serious.
Concussions can occur without loss of consciousness.
Concussions can occur in any sport.
Recognition and proper management of concussions when they first
occur can help prevent further injury or even death.
are sometimes called mild traumatic brain injuries (MTBI). They are
caused by a bump, blow, or jolt to the head. Concussions can occur in
any sport, including these:1, 2
for concussions is greatest in athletic environments where collisions
are common.3 Environmental factors also can cause injury. For
example, a player may collide with an unpadded goalpost or trip on an
uneven playing surface.
Sometimes people do not recognize that a bump, blow, or jolt to the head
can cause a concussion. As a result, athletes may receive no medical
care at the time of the injury, but they may later report symptoms such
as headache and dizziness. These symptoms can be a sign of a concussion.4
estimated 300,000 sports- and recreation-related head injuries of
mild to moderate severity occur in the United States each year.5
Most can be classified as concussions.
and high school football players who have had at least one
concussion are at an increased risk for another concussion.6, 7
concussion that occurs before the brain recovers from the
first—usually within a short period of time (hours, days, or
weeks)—reportedly can result in brain swelling, permanent brain
damage, and even death. This condition is called second impact
Signs and Symptoms
One or more of
these signs and symptoms may indicate that a concussion has occurred.10
Remember that concussions can also occur with no obvious signs or
symptoms. Any of the symptoms listed in this table should be taken
seriously. Athletes who experience these signs or symptoms after a bump,
blow, or jolt to the head should be kept from play until cleared by a
health care professional.
SYMPTOMS REPORTED BY ATHLETE
|Appears dazed or
|Is confused about
||Balance problems or
|Is unsure of game,
score, or opponent
||Double or fuzzy vision
||Sensitivity to light or
||Feeling foggy or groggy
behavior or personality changes
Concentration or memory problems
|Can’t recall events
prior to hit
|Can’t recall events
Prevention and Preparation
Insist that safety comes first. Teach athletes safe playing
techniques and encourage them to follow the rules of play. Discourage
all unsportsmanlike conduct and support strict officiating of games.
Make sure athletes wear the right protective equipment for their
activity (such as helmets, padding, shin guards, and eye and mouth
guards). Protective equipment should fit properly, be well maintained,
and be worn consistently and correctly.
Teach athletes that it’s not smart to play injured. Sometimes
players, parents, and other school officials wrongly believe that it
shows strength and courage to play injured. Discourage others from
pressuring injured athletes to play. Don’t let athletes persuade you
that they’re “just fine” after they have sustained any bump, blow, or
jolt to the head.
Prevent second impact syndrome. Keep athletes with known or
suspected concussion from play until appropriate medical personnel have
evaluated them and have provided permission for returning to play.
Remind your athletes: It’s better to miss one game than the whole
When a Concussion Occurs
If you suspect that a player has a concussion, implement your action
plan by taking
the following steps:
athlete from play. Learn how to recognize the signs and symptoms of
concussion in your players. Athletes who experience signs or
symptoms of concussion should not
be allowed to return to play. When in doubt, keep the player out of
that the athlete is evaluated
by an appropriate health care professional. Do not try to judge the
severity of the injury yourself. Health care professionals have a
number of different methods that they can use to assess the severity
athlete’s parents or guardians about the known or possible
concussion and give them the fact sheet on concussion. Make sure
they know that the athlete should be seen by a health care
athlete to return to play only with permission from an appropriate
health care professional. Prevent second impact syndrome by delaying
the athlete’s return to the activity until the player receives
appropriate medical evaluation and approval for return to play.
1. Powell JW, Barber-Foss KD. Traumatic brain injury in high school
athletes. Journal of the American Medical Association 1999;282:958–963.
2. Harmon KG. Assessment and management of concussion in sports.
American Family Physician 1999 Sep 1;60(3):887–892, 894.
3. Powell JW. Cerebral concussion: causes, effects, and risks in sports.
Journal of Athletic Training 2001;36(3):307–311.
4. Kushner DS. Mild traumatic brain injury. Archives of Internal
5. Sosin DM, Sniezek JE, Thurman DJ. Incidence of mild and moderate
brain injury in the United States, 1991. Brain Injury 1996;10:47–54.
6. Guskiewicz KM, Weaver N, Padua DA, Garrett WE. Epidemiology of
concussion in collegiate and high school football players. The American
Journal of Sports Medicine 2000;28(5):643–650.
7. Zemper ED. Two-year prospective study of relative risk of a second
cerebral concussion. American Journal of Physical Medicine and
Rehabilitation 2003 Sep;82:653–659.
8. Institute of Medicine (US). Is soccer bad for children’s heads?
Summary of the IOM Workshop on Neuropsychological Consequences of Head
Impact in Youth Soccer. Washington (DC): National Academy Press; 2002.
9. Centers for Disease Control and Prevention (CDC). Sports-related
recurrent brain injuries—United States. Morbidity and Mortality Weekly
Report 1997;46(10):224–227. Available at:
10. Lovell MR, Collins MW, Iverson GL, Johnston KM, Bradley JP. Grade 1
or “ding” concussions in high school athletes. The American Journal of
Sports Medicine 2004;32(1):47–54.
Centers for Disease Control and Prevention
This website has English and Spanish fact sheets and brochures on
concussion and traumatic brain injury.
Brain Injury Association of America
This organization provides information and resources to improve the
quality of life for individuals with brain injuries.
CDC does not endorse the articles, products, or guidelines of other
organizations or individuals referenced in these materials. CDC provides
this information to raise awareness about the magnitude of concussion in
high school sports as a public health issue and to offer a scientific
overview of the topic.
Centers for Disease Control and Prevention gratefully acknowledges the
following organizations for their participation in this project:
American Academy of Pediatrics
American Association for Health Education
American College of Sports Medicine
American School Health Association
Association of State and Territorial Health Officials
Brain Injury Association of America
Institute for Preventative Sports Medicine
National Association for Sport and Physical Education
National Athletic Trainers’ Association
National Federation of State High School Associations
National Safety Council
North American Brain Injury Society
University of Pittsburgh Medical Center Sports Medicine Concussion
U.S. Department of Education