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.