Why high school boys fear reporting concussions

Male and female high school athletes have moderate levels of knowledge about concussion symptoms, but the boys are much more likely to not report concussions for fear of seeming weak, a small U.S. study suggests.

The reasons boys gave for not wanting to report a concussion tended to center around not wanting coaches or teammates to think they were weak or to "get mad," researchers report in the Journal of Athletic Training. "Although males and females have similar concussion symptom knowledge, we still see a negative stigma" with reporting them, lead author Jessica Wallace told Reuters Health by email.

"Especially within male dominated sports, we are seeing that many male athletes are not reporting because they are highly sensitive to how their peers and coaches view them," said Wallace, an athletic trainer and researcher at Youngstown State University in Ohio. Wallace thinks better concussion education programs are needed to teach kids the dangers of continuing to play with a concussion.

Concussion symptoms can include headache, dizziness and difficulty concentrating or sleeping. In all, 22 concussion symptoms are typically included in sport-related concussion education programs, the study team writes. Athletes who continue to play with a concussion risk re-injury and a longer recovery time.

To determine how well high school athletes recognize these symptoms and how likely they are to report a concussion, as well as why they wouldn’t, the researchers enrolled 288 athletes (198 boys and 90 girls) at three Michigan high schools.  The participants answered a single survey that included a test of recognition of concussion symptoms.

The survey also asked whether the student had ever experienced a concussion, how many concussions they had reported to a trainer, coach, parent or other authority figure, and reasons for not reporting the symptoms. Of the 58 participants who had sustained a concussion, 25 reported having had two or more. Knowledge of symptoms was similar between the sexes, with scores ranging from about 11 to 18 out of a possible 21 on the test.

The top reason for both boys and girls to not report a concussion was because they did not think it was serious. Other common reasons included not wanting to lose play time and not wanting to let the team down. The boys were anywhere from four to 11 times less likely than girls to report concussions, for reasons having to do with how they were perceived by peers and coaches.

It is important for athletes, parents, and coaches to understand that concussion is a treatable injury, but "an athlete has to report the injury for it to be treated," Wallace said.

"If an athlete fails to report the injury and continues to play while symptomatic, it can either delay recovery or potentially result in a catastrophic outcome," she said. Coaches need to emphasize that concussions are serious and that reporting concussion symptoms is expected, Wallace added.

She suggests using a “buddy system” of reporting concussions. "Often, athletes will not report their own concussion, but they will be mindful and protective of their teammates. So the 'buddy system' would help me as the athletic trainer because the athletes would come and tell me if they thought their teammate/friend was experiencing a concussion or concussion symptoms," she said.

“Studies such as these are building blocks to helping us understand how to provide effective and impactful interventions to help athletes better report their injuries,” said Zachary Kerr, an exercise and sport science researcher at the University of North Carolina at Chapel Hill. “Barriers to concussion reporting by athletes need to be resolved, with an emphasis not only on education and knowledge, but also the pressures that athletes face from peers, adults, and their own perceptions,” said Kerr, who wasn’t involved in the study.