A New Game Plan: #TeamUp4ConcussionSafety

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Contact and collision sports at all levels are characterized by what some call a “culture of resistance” by athletes to honest self-reporting of concussion symptoms, and other call the “code of silence.”

From an early age, and throughout their athletic career, too many athletes are under pressure from parents, teammates, and coaches to play hurt and hide their concussion symptoms; develop a belief that playing with concussion symptoms – at the risk to their own health – is not only acceptable, but expected; and are criticized, penalized, and ostracized if they do not abide by these team and cultural norms.

Up to now concussion education has focused almost exclusively on teaching coaches, athletes, and parents about how to recognize the signs and symptoms of concussion and providing information about the health risks of concussion and repetitive head trauma, in the hopes that an athlete, knowing the symptoms of  concussion, and knowing the risks from continuing to play, won’t be willing to risk further injury and will report their symptoms to the coach, athletic trainer, or a parent right away.

Unfortunately, such education hasn’t worked to change the concussion reporting behavior of athletes, with between 40 and 60 percent of all concussions – and a much higher percentage of so-called “bell-ringer” events – still going unreported, and a recent study finding that four out of ten athletes with concussion signs or symptoms return to play that same day.


Research over the last decade reveals that the top ten reasons athletes consistently give for not immediately reporting concussion symptoms are that: 

  1. They did not think they suffered a concussion,
  2. They did not believe it was serious enough to report,
  3. They were not aware of the potential negative health consequences from continued participation;
  4. They believed that they could safely delay disclosure until their removal was less likely to affect game or practice play, or until the symptoms got so bad they could no longer be ignored;
  5. They did not want to be removed from the game or practice;
  6. They did not want to disappoint coaches, teammates, parents, and fans by coming out of the game;
  7. They felt pressure from coaches, teammates, parents, and fans to play injured;
  8. They believed that coaches, teammates, parents, and fans expected them to play injured;
  9. They feared suffering negative consequences if they reported concussion symptoms, such as loss of playing time or position as a starter position, or having their toughness questioned;
  10. They did not think their own positive attitude toward concussion symptom reporting was shared by the coach, medical staff, and teammates, so that they hid their symptoms for fear of social disapproval.

Of the ten, fully half have nothing to do with knowledge of concussion signs and symptoms or the health risks of concussions, but everything to do with an athlete’s attitudes and beliefs about concussion reporting; what they think might happen to them if they report, and what they think are negative attitudes of coaches, teammates, parents, and fans about concussion reporting; all of which combine to create a climate which discourages reporting.  

Attitude Adjustment Time

So SmartTeams™ is trying something different – or, in the parlance of American football, a new game plan – to increase the rate at which athletes report concussion symptoms, one which recognizes that chronic under-reporting stems less from an athlete’s lack of knowledge about concussion symptoms and the health risks of continuing to play with such symptoms, as from a belief by athletes that they are expected to play through injury (even a head injury), a belief that the coach, teammates, parents, and fans would be disappointed if they didn’t shake off the injury and stay in the game, and, even if they believed it was the safer course, a belief that they would be violating the team’s code of silence and wouldn’t be viewed as a good teammate if they reported. 

Like the Centers for Disease Control and an increasing number of concussion experts, SmartTeams™ believes that the best way to increase the rate at which athletes report concussion symptoms, either their own or their teammates, is for coaches, parents, medical staff to work as a team to change reporting behavior – to reshape the culture around concussion reporting – by changing individual and team reporting attitudes and norms and by creating a climate in which athletes feel comfortable reporting their symptoms.

The #TeamUp4ConcussionSafety™ program, developed by MomsTEAM Institute as part of its SmartTeams Play Safe™ initiative with a Mind Matters Educational Challenge Grant from the National Collegiate Athletic Association and Department of Defense, and through the additional, generous support of our sponsors and underwriters, is designed to increase reporting by athletes of concussion symptoms by engaging coaches, athletes, parents, and health care providers in a season-long program which emphasizes that immediate reporting of concussion symptoms not only reduces the risk the athlete will suffer a more serious brain injury – or, in rare cases, even death – but is actually helps the team’s chances of winning, not just in that game, but, by giving athletes the best chance to return as quickly as possible from concussion, the rest of the season, and by teaching that honest reporting is a valued team behavior and a hallmark of a good teammate.

Five Steps 

The SmartTeams™ #TeamUp4ConcussionSafety™ program consists of five steps:

  1.  Testing Knowledge and Attitudes

The rate at which student-athletes immediately and honestly report experiencing concussion symptoms, both their own and their teammates, will only begin to increase if all stakeholders first understand how much they know about concussions, and about their current attitudes towards and beliefs about symptom reporting.

To find out what coaches, athletes, athletic trainers, and parents know about concussions, and, more importantly, whether they view concussion symptom reporting in a positive or negative light, every stakeholder will be asked to complete a series of  quizzes.

  1.  Completing a Concussion Safety Course

While knowledge and awareness of concussion has increased substantially over the sixteen years that MomsTEAM/SmartTeams™ and others, particularly the CDC, have been engaged in concussion education, research shows that there are still important gaps that need to be filled.

To fill in those gaps, coaches, parents, and athletes will be encouraged in Step Two in the #TeamUp4ConcussionSafety program to continue learning about concussions by:

  1.  Attending a Concussion Safety Meeting

Because studies show that one-off concussion education isn’t enough to change concussion symptom reporting behavior, Step Three in the SmartTeams Play Safe™ #TeamUp4 ConcussionSafety™ game plan calls for coaches, athletes, athletic trainers, team doctors (and, at the youth and high school level, parents) to attend a mandatory concussion safety meeting before every sports season to learn in detail about the importance of immediate concussion symptom reporting, not just in minimizing the risks concussions pose to an athlete’s short- and long-term health, but in increasing the chances for individual and team success.  

  1.  Taking a Concussion Safety Pledge

Anecdotal evidence from NCAA Division I football programs suggests that the signing by athletes of pledges acknowledging their responsibility to report concussion symptoms increases the rate of reporting by athletes, both of their own symptoms and those of teammates.  Because improving concussion safety requires a team effort, we believe that all those with a stake in concussion safety should sign pledges, not just athletes.  

Step Four of our new concussion safety game plan calls for athletes, coaches, parents, and medical staff to demonstrate in a tangible way their commitment to creating a culture in which immediate reporting of concussion symptoms by athletes is a valued team behavior and the sign of a good teammate by signing a concussion safety pledge, at or shortly after the pre-season concussion safety meeting, 

  1.  Staying Involved/Sharing Successes

Because prevailing attitudes towards concussion symptom reporting and reporting behavior are deeply entrenched in our sports culture, we encourage coaches, athletes, athletic trainers, team doctors, and parents to continue working over the course of the sports season to create and maintain an environment in which athletes feel safe in immediately reporting concussion symptoms (both their own and their teammates) by sharing and reinforcing positive messages about the importance of immediate concussion symptom reporting via social media (we encourage sharing success stories and positive messages @SmartTeams on Twitter a other social media) and by maintaining open lines of communication and an ongoing dialog about concussion safety between and among coaches, athletes, medical staff, and parents.

Four Goals

The goals of the SmartTeams Play Safe™ #TeamUpe4Concussion Safety™ program are to instill the following four messages:

  1. In honestly and immediately self-reporting concussion symptoms, and encouraging teammates to do the same, athletes are not letting the coach, teammates, parents, and fans down, but are helping the team’s chances of success;
  2. Honestly and immediately self-reporting concussion symptoms, and encouraging teammates to do the same, are hallmarks of a good team player;
  3. Delaying the reporting of concussion symptoms – or hiding them completely – puts an athlete’s health and even those of their teammates at risk by exposing their already injured brain to further damage, potentially even death, by prolonging the time it takes for them to recover by almost a week, and by doubling their chances of needing 8 or more days to be cleared to return to contact practice; and
  4. Not honestly and immediately reporting concussion symptoms can hurt an individual’s and the team’s performance, not just in the game in which the athlete sustains a concussion, but in future games in which the athlete is unable to play.

With consistent messaging and constant reinforcement of the value of immediate concussion reporting in achieving your team’s performance goals, and by making athletes feel comfortable in reporting, we believe that, not only will  attitudes and beliefs about concussion reporting begin to change, but the concussion reporting behavior of your athletes will start to change as well, and that, over time, the culture of resistance to concussion symptom reporting will be replaced by a sports culture of concussion safety.

Since this is a pilot program, we invite you to share your feedback, comments, suggestions, and constructive criticism (emphasis on the word “constructive”) with us so we can make the program the best it can be.  

Test Your Concussion Knowledge, Attitudes, and BehaviorsConcussion Challenges/Quizzes

Concussion Education: Take A CourseOnline Concussion Training

Concussion Safety: The Team MeetingConcussion Safety Meeting

Since you’re here …

… we have a small favor to ask.  More people are visiting the SmartTeams family of websites, but far fewer are paying for it.  So you can understand why we need to ask for your help.  It takes a lot of time, money, and hard work to produce the kind of independent, objective, and well-researched information on sports safety that we have been providing for the past 16 years and that you  expect from MomsTEAM and SmartTeams. But we do it because we believe our perspective matters, and that it might well be your perspective, too.

Help fund SmartTeams and together we can keep parents, coaches, athletes, and health care providers informed.

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