Concussion Management in School Sports: Culture and Communication


Concussion communication can sometimes be ineffective in coaches, parents, and athletes

Concussions are a common sports injury among middle school athletes, with potential long-term effects on their young brains.

Many middle schools in the U.S. still don’t have access to athletic trainers, which raises concerns over how concussions are managed in this setting. To make matters worse, there is very little research on concussions in the middle school setting, despite the plethora of concussion research that has emerged over the past decade.

In response to these concerns, a team of researchers based out of the University of North Carolina at Chapel Hill conducted a study to explore sport culture and communication in the middle school setting regarding concussion education and management. Today on the blog, we feature this new research!

The Qualitative Research Study

The research study was qualitative, meaning that it involved interviewing the study participants followed by analyzing their responses for themes that emerged from the interviews. The participants were athletes, parents, and school staff, which included coaches and school nurses, from seven middle schools during the years of 2018-2020.

In this study, the researchers focused on sport culture and communication, with the ultimate goal to identify areas for improvement in concussion communication in the middle school sports setting.

Sports Culture in Middle School

In terms of sport culture, the researchers were pleased to find that there was a general focus on play and fun, over competitiveness, at the middle school level. All groups (athletes, parents, and staff) noted the importance of safety in middle school sports. Coaches said they have observed improvements over the years in athlete safety and preventative measures for concussions. Athletes noted that their coaches were teaching them safe play, and parents recognized that safety was a priority over winning.

However, despite these pleasing findings, there were concerns over how well policies were being implemented at the middle school level. A lot of these concerns were related to communication.

Communication Regarding Concussions in Middle School Sports

The study found that the topic of concussion was rarely discussed among teammates and was mostly discussed, if at all, by coaches and parents. There was little communication on preventative measures for concussions. Athletes mostly conversed with one another about sports, while coaches mostly discussed gameplay, skill development, in-game rules, and general safety. Parents tended to converse about concussions with other parents only when one of the athletes on the team was concussed.

The study also found several barriers to concussion communication among participants. The coaches mentioned that athletes do not retain education information because the athletes do not think that they will be affected by concussions. The coaches also identified the following barriers to communication: 1) the parent not caring about concussion, 2) parent or athlete failing to notify the coach when a concussion occurred outside the school setting, and 3) fear of the coach being blamed for the concussion. School staff recognized that middle schoolers may face other barriers such as language barriers and cultural differences.

Interestingly, the school staff and coaches also noted that social media and movies (such as “Concussion”) made parents scared of concussions, while at the same time opening them up to discussing concussions more often than in the past.


The researchers recommend several strategies, including providing coaches and school staff with appropriate educational materials, adequate training, and resources. They also suggest establishing clear and consistent pathways of communication among athletes, parents, coaches, and staff. Lastly, the study highlights the importance of traditional and social media in shaping parent perceptions and recommends using these platforms to promote concussion education and enhance communication.

Improving sport culture and communication about concussions among middle school athletes, parents, and coaches is essential for the future of concussion education and management in the middle school setting.


Kerr ZY, Gildner P, Parker SK, Kostogiannes V, Callahan CE, Nedimyer AK, Kossman MK, Chandran A, Register-Mihalik JK. Sport culture and communication among middle school athletes, parents, and staff: A qualitative study. PLoS One. 2023 Mar 15;18(3):e0282252. doi: 10.1371/journal.pone.0282252. PMID: 36920886; PMCID: PMC10016647.


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