We celebrate National Athletic Training Month with an extensive look at the importance of Athletic Trainers in concussion management.
The prevalence of having one or more concussions related to high school sports or physical activities is over 15%, according to the Centers of Disease Control and Prevention. (1) The prevalence of concussions in collegiate athletes is even greater than that of high school athletes. (2)
Alarmingly, researchers predict that rates of concussion may be even higher than those published in the literature, as many athletes do not report head injuries. Reasons for not reporting head injuries include fear of losing playing time or letting down their teammates. (3)
Increased media coverage has led to heightened awareness of the short and long-term effects of sport-related concussions. In addition, it has led to a greater awareness of the importance of an extensive and qualified medical team in management of athletes suffering concussions.
At the forefront of this medical team is the athletic trainer.
Athletic trainers are often the first line of medical care of sport-related concussions. Working alongside the team physician, the athletic trainer is a qualified healthcare professional trained in the prevention, emergent care, diagnosis, and rehabilitation of injuries and medical conditions. (4)
The Four Crucial Roles of Athletic Trainers in Concussion Management
In this blog, we will discuss the crucial roles of athletic trainers as valued healthcare team members in the management of concussions. The four key roles that will be discussed are Prevention, Evaluation and Treatment, Return to Play Protocols, and Policy Compliance. While this list is not all-encompassing, these and further roles are supported by the latest research and recommendations from the most recent Position Statement of the National Athletic Trainers’ Association. (5)
1. Prevention of Concussions
Athletic trainers are present at athletic events (both practice and competition) to observe and monitor athletes participating in sport and activity. This includes preventing concussions from happening in the first place. To do so, athletic trainers are involved in equipment maintenance (for example, properly fitting and inspecting certified helmets). The athletic trainer also works with both school and referee officials to ensure that field and playing conditions are safe (for example, the metal poles of soccer goals are properly padded).
Athletic trainers are also heavily involved in educating athletes, parents, coaches, and school officials about prevention of concussions. Research shows that athletes with access to an athletic trainer are more knowledgeable about concussions than athletes without access to an athletic trainer. (3) An example of concussion prevention education includes stopping ‘head-down’ contact in football. (6) Other education topics, outlined by the Public Health Agency of Canada, should include definitions of concussions, mechanisms of injury, signs/symptoms, and protocols for properly identifying and treating concussions. (7)
Although athletic trainers make every effort to prevent injuries, concussions will still happen. Research trends show that concussion rates are on the rise, with a 4.2-fold increase in high school sports from 1997 to 2008. (8) Therefore, the need for athletic trainers to be available for thorough evaluation and treatment is crucial.
2. Evaluation and Treatment of Concussions
From the sidelines to the athletic training room, to ‘return to play’ protocols, athletic trainers are evaluating concussions. When a head injury occurs on the field or during competition, athletic trainers are responsible for removing athletes from play. They are experts in making rapid sideline evaluations to determine if athletes can resume play or should stay removed for further evaluation and diagnosis. Diagnosis of concussions occurs via clinical measures and standardized assessment tools. (5) The basis of concussion evaluation is daily symptom tracking (monitoring headache, dizziness, nausea, mood changes, etc.). These evaluations require multiple assessments over time, as some concussions can take weeks to months to resolve. (9)
Athletic trainers are best suited for these evaluations because they know the know the athletes best, quite often interacting with their athletes daily.
Athletic trainers are also responsible for conducting baseline testing. Baseline testing is the collection of standard in-person and computerized assessments at the beginning of a sports season to gather information about neurocognitive status prior to injury. Not surprisingly, conducting baseline testing is quite cumbersome, particularly at the high school level where often one athletic trainer oversees >500 athletes!
Athletic trainers go above and beyond to follow-up with their patients. As recommended by the NATA Position Statement, this involves providing home-care instructions to athletes and/or their parents. (5) Many athletic trainers will even make home calls to check-in and ensure that their athletes are complying with their home-care instructions.
3. Return to Play Protocols
When an athlete no longer reports symptoms, the athletic trainer then initiates the return to play protocol. Although return to play protocols can vary from country or state, consensus statements from international and national entities include a gradual 6- or 7-step progression. (5, 10, 11) The progression begins with returning to school and sedentary activities, followed by gradual return to physical activity (light to moderate to intense physical activity), and finally return to sport (practice and contact training, then full competition).
Athletic trainers oversee all steps of the return to play protocol and are responsible for monitoring symptoms and determining when the athlete is ready for the next step. They also coordinate with the athlete’s physician and healthcare team to determine readiness for progressions and, eventually, full medical clearance to return to sport.
Another important, less appreciated, aspect of concussion management is ‘return to learn.’ Athletic trainers also work with school teachers and officials to ensure their student athletes experience a safe and effective ‘return to learn’ in school.
4. Policy Compliance
Athletic trainers are responsible for staying compliant with current laws, policies, and guidelines from national/state, governing bodies, and position statements. They must create and edit their policy and procedure manuals accordingly.
The athletic trainer is also responsible for ensuring proper documentation of all aspects of concussion management: mechanism of injury, evaluations, symptom tracking, treatments, instructions to parents, communications with healthcare team, and return to play compliance and progression. (5) Given their central role to the healthcare team, athletic trainers can be best described as the liaison between athletes and their coaches, parents, and healthcare team.
Future Directions of Concussion Management
More and more countries, states, and governing bodies are adopting concussion policies and protocols. (5, 7, 10, 11) Although there is still a shortage of athletic trainers, particularly in high school and youth sport settings, we are encouraged by the evidence showing the use of athletic trainers is increasing. (12) Further, individuals and companies are using technology to advance concussion management practices and tools. We look forward to the enhanced integration of technology in concussion management in the future.
If you’re an Athletic Trainer, check out how HeadCheck Pro can help you in all aspects of concussion management.
About the Author
Dr. Jennifer Hunnicutt is a licensed athletic trainer with a PhD in Health and Rehabilitation Science, who has worked with all types of athletes, including professionals and Olympians. She has held prominent research positions at Emory Sports Medicine and the NBA Hawks Center in Atlanta, GA, as well as serving on the national network of healthcare providers for U.S. Figure Skating. Now the owner of Hunnicutt Writing and Consulting, LLC, Dr. Hunnicutt collaborates with global institutions, spearheading innovation and research among professionals and businesses in Sports Medicine and Orthopedics. Learn more at https://drhunnicutt.com.
- DePadilla L, Miller GF, Jones SE, Peterson AB, Breiding MJ. Self-Reported Concussions from Playing a Sport or Being Physically Active Among High School Students – United States, 2017. MMWR Morb Mortal Wkly Rep. 2018;67(24):682-685.
- Daneshvar DH, Nowinski CJ, McKee AC, Cantu RC. The epidemiology of sport-related concussion. Clin Sports Med. 2011;30(1):1-vii.
- Wallace J, Covassin T, Nogle S, Gould D, Kovan J. Knowledge of Concussion and Reporting Behaviors in High School Athletes With or Without Access to an Athletic Trainer. J Athl Train. 2017 Mar;52(3):228-235.
- Athletic Training. National Athletic Trainers’ Association. https://www.nata.org/about/athletic-training.
- Broglio SP, Cantu RC, Gioia GA, et al. National Athletic Trainers’ Association position statement: management of sport concussion. J Athl Train. 2014;49(2):245-265.
- Casa DJ, Guskiewicz KM, Anderson SA, et al. National athletic trainers’ association position statement: preventing sudden death in sports. J Athl Train. 2012;47(1):96-118.
- Canadian Guideline on Concussion in Sport. Public Health Agency of Canada. July 2017. https://www.parachutecanada.org/en/professional-resource/concussion-collection/canadian-guideline-on-concussion-in-sport/.
- Lincoln A, Caswell S, Almquist J, Dunn R, Norris J, Hinton R. Trends in Concussion Incidence in High School Sports: A Prospective 11-Year Study. Am. J. Sports Med. 2011; 30(10).
- Covassin T, Bretzin AC, Beidler E, Wallace J. Time-to-Event Analyses: Return to Unrestricted Participation After Sport-Related Concussion in a Cohort of High School Athletes. J Athl Train. 2021 Feb 22. doi: 10.4085/1062-6050-0150-20. Epub ahead of print. PMID: 33618355.
- Returning to Sports and Activities. CDC HEADS UP. CDC Injury Prevention & Control. https://www.cdc.gov/headsup/basics/return_to_sports.html.
- McCrory P, Meeuwisse W, Dvorak J, et al. Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016British Journal of Sports Medicine 2017;51:838-847.
- Huggins RA, Coleman KA, Attanasio SM, et al. Athletic Trainer Services in the Secondary School Setting: The Athletic Training Locations and Services Project. J Athl Train. 2019;54(11):1129-1139.