Under-reporting concussion symptoms continues to be a worrisome trend among youth sport participants (aged 12-17 years). Coaches are also struggling to manage the responsibility of removing athletes from play.

Why wouldn’t youth sport participants disclose concussion symptoms during play?

Why wouldn’t coaches remove athletes from play?

Our interdisciplinary research team, with members from several universities and sport and safety organizations, collaborated on a review of research addressing these questions. These are important considerations for effective concussion management that highlight a gap in concussion protocols and guidelines. “We develop policy with the very best intentions, but we make assumptions about how people will interact with the protocol and we find ourselves struggling with the myth of compliance” (Brandy Tanenbaum, Sunnybrook Health Sciences Centre, research team member). Failure to “remove the athlete from play” has serious implications for risk of further injury and longer recovery for youth sport participants.

Our summary of 36 studies across a variety of sports captures the influences that may restrain youth athletes from disclosing a possible concussion, and coaches removing them from practice or a game.

We are pleased to share this summary, along with strategies for supporting a culture of self-reporting and removal from play, through a video Concussion Symptom Under-Reporting and Removal From Play in Youth Sport and infographics in English “It’s not that bad” and French “Ce n’est pas si mal”.

The findings of our review highlight the personal, social and cultural factors that may keep youth participants from self-reporting and coaches removing athletes from play. There is a tendency to “treat concussion as something that is individualized, and as a personal trouble. But it is a structural and systemic issue that requires attention to social relations” (Dr. Parissa Safai, York University, research team member). Our work highlights that “there are sociocultural pressures around [self-reporting and removal], but we are targeting individuals’ knowledge. What are we doing about all these [other] factors? [Our findings highlight] a force field that shows us where we have to target change and intervention” (Stephanie Cowle, Parachute, research team member).

Evidence-informed strategies for change include:

• Developing and sustaining a participant-centred team/sport environment;
• Concussion education for all, at multiple time points, that includes a focus on the driving and restraining influences to self-reporting and removal;
• Reframing disclosure as positive;
• Countering negative social norms of ‘playing through pain’ and ‘toughing it out.’

“This project has allowed us to investigate and better understand human behaviour that can be influenced by several aspects of sport culture as it pertains to the self-reporting and removal of athletes. These learnings will help to better educate everyone in sport, to ensure athletes enjoy their sport participation experience and develop within a safe environment” (Johnny Misley, CEO Ontario Soccer, research team member).

“The Coaches Association of Ontario is excited to see the release of these new resources on concussion reporting and removal from play in youth sport. Coaches play a critical role in the recognition and removal steps of concussion management. The research highlighted in these resources clearly endorses coaches who create a participant-centered environment and are trained and educated on concussions. Coaches with this approach, knowledge, and training can have better reporting and removal outcomes with youth. Evidence informed resources, such as these, are key to making sport safer for everyone” (Mercedes Watson, Coaches Association of Ontario, research team member).

Contact:

Dr. Alison Doherty
Research Team Lead and Professor, Western University
adoherty@uwo.ca

With Jeff Caron (U. de Montréal), Stephanie Cowle (Parachute), Debra Gassewitz (SIRC), Annette Greenhow (Bond University), Johnny Misley (Ontario Soccer), Kaleigh Pennock (U. Waterloo), Brendan Riggin (U. Waterloo), Parissa Safai (York University), Shannon Sibbald (Western University), Brandy Tanenbaum (Sunnybrook Health Sciences Centre), Mercedes Watson (Coaches Association of Ontario)

The knowledge resources draw on research supported by the Social Sciences and Humanities Research Council of Canada.