Coaches

Myths about concussions
What types of collisions, falls, hits may cause a concussion?
How can I educate my athletes and parents about the invisible injury of concussion?
What is baseline testing? How can I sign my team up for baseline testing?
What should I look out for to keep my players safe?
When should an athlete go to an ER?
Helpful Apps to help coaches and parents with injury reporting and symptom monitoring
What can I do if there is no Athletic Trainer at my team’s practice or game?
What is return to play protocol?
When does a player get cleared?
Do helmets, mouth guards and headbands protect against concussion?
Are there exercises to help decrease the chance of concussion?
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Myths about concussions


What types of collisions, falls, hits may cause a concussion?

Concussions can happen in to males and females, in all sports, and in various ways. Head to head collisions are the most obvious, but the majority of concussions are a result of a jolt to the body causing a whip of the head. The videos below show just how easily a concussion can occur in any sport.


How can I educate my athletes and parents about the invisible injury of concussion?

Education is the first step toward keeping players safe regardless of the injury. With concussions, there has been more research to help us understand the injury, how to spot a possible concussion, as well as the recovery management process. As a coach you can address your concussion protocol at the very first parent meeting or practice. At this meeting it will be helpful to have parents and athletes review, sign, and return the CDC Student Athlete/Parent Information Sheet. (This sheet can be downloaded or ordered online free of charge from the CDC.)

The Brain 101 site has a short video that is geared toward youth sports and how to help spot a possible concussion as well as the recovery process. A coach who requires players and parents to watch this video is taking a good step toward early recognition of and response to injury. The Brain 101 program can be accessed here: http://brain101.orcasinc.com/5100/. There is also a Brain 101 program for Coaches here: http://brain101.orcasinc.com/4000/.

When an athlete suffers a possible concussion, every “adult link” in his or her chain of care is important, especially the coach and the athlete’s parents. Having a communication protocol in place with parents is crucial to helping the athlete get the care they need so they can recover quickly and return safely back to the field. Please see our Helpful Apps section on ways to recognize and report injury and monitor signs and symptoms. Parents can benefit from information on next steps if their child suffers a head injury. The very first link in the chain is the athletes. Educated athletes will hopefully speak up and be honest about what they are feeling, but a coach can help make sure all the information gets to the parent to assure they know to monitor their child and follow up with a medical professional who is trained in concussion management best practices. Having an injury report form available for the coach’s records as well as a copy for parents is very helpful for communication purposes.

Additional educational resources can be found on our Resources page or below:

What is baseline testing? How can I sign my team up for baseline testing?

Baseline testing is done prior to beginning a sports season when a player is healthy (uninjured). Depending on the age of the athlete, there are different options for baseline testing. Athletes six to ten years of age may do a King Devick eye tracking test, as well a baseline balance assessment. The King Devick test can be done anywhere and takes less than 5 minutes. (Learn more about the King Devick test)

Coaches who would like help with free King Devick team screening can sign up by calling HeadZone at 203-538-5400. Testing can be done at your team’s practice site or on site at HeadZone. A coach can keep his or her players’ King Devick baseline times in their phone to access when needed during rapid sideline evaluations. An athlete should repeat this test PRIOR to returning to play if a concussion is suspected. A post-injury speed > 5 seconds longer than baseline requires that the athlete be removed from play for a medical evaluation. The King Devick test can be administered by a safety parent, coach, or assistant coach which makes it a very helpful tool if there is no medical professional on site.

For athletes over 10 years of age, a baseline ImPACT test can be taken in combination with the King Devick test. The ImPACT test is a thinking workout, taken on a computer that challenges memory, speed, and cognitive function. The ImPACT takes roughly 30 minutes to complete. Coaches who would like ImPACT screening for their teams can call HeadZone to arrange time and place (testing can be done on site at HeadZone or at your team’s location). At HeadZone Concussion Care all ImPACT baselines are reviewed by a medical professional. One free repeat is offered to any tester whose results may not reflect the best measure of their normal performance. An ImPACT baseline test is valid for one year for athletes 10-12, and for two years for athletes 13 and older. The video below is helpful in explaining the use of ImPACT testing after injury for an athlete.

When an athlete has a baseline ImPACT test, it is very helpful to measure post injury results to pre-injury results, to see if their memory, processing speed, or reaction time are being affected by the injury. Since each individual takes the test differently, it’s helpful to use an athlete’s return to their baseline scores as one indicator of recovery. A good baseline can actually help an athlete get back onto the field, court, or track faster. (Learn more about the ImPACT test)

What should I look out for to keep my players safe?

At the beginning of each season all coaches should teach their players and parents about concussion and the dangers of hiding the injury. Many athletes strive to play as long as they can, often pushing through an injury. In addition, athletes want to please their coach and often will not speak up because they are afraid to let their coach, teammates, or parents down. Coaches need to make it known to players that when it comes to their head, THEIR BRAIN, it is not ok to push through. Knowing that a coach will be supportive when an athlete speaks about their symptoms can help an athlete do what is best for their health. The more education you can give the athletes and parents, the easier it will be for the athlete to speak up, get the right care in a timely fashion, recover and get back out there. The Center for Disease control has free information that you can order or have parents download. Brain 101 also has great information to help parents, coaches and athletes become educated on concussions.

If you suspect a player may have a concussion, there are several signs you can look out for. Signs are what the coach or safety parent observe from the injured athlete. A coach who does not have an assistant or athletic trainer can designate a safety parent to be in charge of monitoring for injuries.

Signs Coaches May Observe that Indicate a Possible Concussion:

  • Athlete appears dazed or stunned
  • Athlete is confused (may not understand what to do in a situation)
  • The athlete may seem forgetful as compared to their norm
  • The athlete may not know the score of the game, opponent, or where they are.
  • Clumsy movement by the athlete that does not reflect their normal movement
  • Slow or delayed answers to questions compared to norm
  • Loss of consciousness
  • Behavior, personality, or mood changes
  • Problems recalling events that happened before the possible injury
  • Problems recalling events that happened after the injury

Coaches can also pay attention to what their athlete reports in regard to how they are feeling. These reports from the athlete are called symptoms. After a concussion, an athlete may report the following symptoms:

  • Pressure in the head, or headache
  • Nausea or vomiting
  • Balance problems or dizziness
  • Problems with vision (blurry vision or double vision)
  • Sensitivity to light
  • Sensitivity to noise
  • Feeling slowed down, hazy, foggy, or groggy
  • Concentration trouble
  • Having a hard time remembering things
  • Confusion
  • Feeling “off”, “not right”, or “feeling down”

If you observe any of these signs, or the athlete is reporting any of these symptoms, then you should remove the player from practice or competition and refer them to their primary care physician or a concussion specialist. If you have removed a player, they should not be allowed to return until you have a note signed from their doctor stating their clearance to play. If a doctor sends a note, but you as a coach are still seeing signs of a concussion, it is important that you keep the player out and inform the parent of your concern and the need for medical re-evaluation.

When should an athlete go to an ER?

Progressive or severe signs and symptoms at the time of injury necessitate a call for EMT and an ambulance. Coaches should always have the protocol for getting an ambulance to their practice facility, a list of nearest hospitals, etc. in case an ambulance needs to be called. In addition, there are some signs that coaches and parents should look out for, especially during the first 24 to 48 hours that may require evaluation in the emergency department, including:

  • Progressive headache
  • Persistent or increasing neck pain
  • Athlete becomes sleepy or falls asleep and cannot wake up
  • If the athlete does not recognize people or places
  • Vomiting
  • Confusion, unusual behavior
  • Seizure
  • Cannot walk or stand unassisted
  • Slurred Speech
  • Difficulty understanding speech or directions
  • Symptoms checklist for athletes

Athletes who are younger may report their symptoms differently than older athletes. Although an athlete who is only 5 years old may not know what nausea is, they will know if their tummy feels ‘funny’ or ‘sick.’ Click here to access a symptom check lists for:

Please see our Helpful Apps section on convenient ways to monitor and report symptoms while on the sideline.

Helpful Apps to help coaches and parents with injury reporting and symptom monitoring

What can I do if there is no Athletic Trainer at my team’s practice or game?

There are many cases where there will not be an athletic trainer on site to help with a concussion evaluation, especially with respect to youth sports, weekend practices, or schools with limited budgets. In addition to monitoring signs and symptoms, a coach, assistant coach, safety officer, or parent can do the following to help spot, not diagnose, a possible concussion. Removal from play is number one if there is possibility of concussion and below are some tools to aid coaches and parents with this decision.

1. Use a modified SCAT or Child SCAT.

The SCAT (Sport Concussion Assessment Tool) is very helpful for Athletic Trainers to use when evaluating for a concussion. Although a coach is not expected to do the entire SCAT evaluation, there are parts of the evaluation that can be done by a coach, assistant coach, or designated safety parent to help determine the status of a player following a jolt or blow to the head (ie. signs and symptoms lists, questions for memory and concentration). To view these sections of the SCAT 3 and Child SCAT 3 please see below.

2. Repeat the King Devick test and check against baseline time.

If you have used the King Devick to get baseline scores for all your players, you can retest your athlete if a concussion is suspected. By repeating the test you can get an objective way of flagging your players for a possible concussion. If the test is repeated on the sideline and your player scores > 5 seconds slower than baseline, or if the athlete makes mistakes, then the athlete should not return to play and should be further evaluated by a medical professional. To learn more about how to use the King Devick on the sideline see below:

What is return to play protocol?

“Best practice” recommendations by the Fourth International Conference on Concussion in Sport are that all athletes are required to successfully complete a supervised graduated exercise program, often termed a “Return to Play” protocol, prior to a final medical evaluation to determine clearance for participation in sports. A ‘return to play protocol’ can be started after an athlete has been symptom free (we recommend symptom free for at least one week) and has successfully returned to their pre-injury level of academic participation. An athlete should not begin the ‘return to play protocol’ until approved to do so by a medical professional. Once approved to begin, the athlete should be supervised though each step by a parent, coach, ATC, or physical therapist. There are five stages in the ‘return to play protocol’ and each step should be separated by at least 24 hours.  If the athlete becomes symptomatic after or during any of the workouts then he or she must stop, rest for 24 hours or until symptom free, then begin again at the previous day’s level. Thus, a ‘return to play protocol’ may take more than five days. As an athlete advances through the protocol they are allowed to increase their physical activity until day five when they may compete in a full contact practice (NOT a competitive game). After the ‘return to play protocol’ has been completed the athlete should then return to their doctor to be evaluated one more time. If all looks well at this medical visit, then the athlete will be cleared for contact sports. Note that studies show that over 27% of asymptomatic athletes will show abnormalities on their cognitive testing after successfully completing a ‘return to play protocol’ and will need a longer recovery time. (http://www.ncbi.nlm.nih.gov/pubmed/?term=mcgrath+concussions+2013). Clearance should not be given to compete in sport until this protocol is completed and a final medical evaluation has taken place allowing the clearance. Coaches should make sure all athletes returning from a concussion have completed a supervised ‘return to play protocol’ and have a signed medical clearance following exertion. Please click here to see a copy of the five stage return to play protocol (Insert copy of HZ RTP guidelines).

When does a player get cleared?

If an athlete has suffered a concussion, then clearance should only come after the athlete:

  • is symptom free
  • has returned to their pre-injury level of academic participation
  • has successfully completed a five stage ‘return to play protocol’
  • has been evaluated and cleared by a medical provider after completing their exertional program

Recovery time is difficult to predict because every injury is unique as are the co-existing factors that might contribute to a prolonged recovery (e.g. migraines, number of prior injuries). If you have an athlete who is medically cleared to play, yet you are concerned that they may not be fully recovered, then inform the parents of your concerns and do not play that athlete until they are re-evaluated. Note that athletes who have had a concussion may be more likely to get another one. To protect these athletes a little more a coach can limit contact for them at practice. For example if the athlete is a football player or hockey player, the coach can allow the player to wear a sports pinnie which will remind their teammates not to hit them. Another strategy to keep players safe is to limit the number of full contact practices allowed each week.

Do helmets, mouth guards and headbands protect against concussion?

There are many products on the market that claim to decrease or prevent concussions. Unfortunately, there is no product that has been shown to prevent concussions, including helmets and mouthguards.  The majority of concussions occur as a result of a “whiplash” or rotational injury and therefore a helmet is not protective against this type of injury. Although helmets will help to protect the skull from fracture, they do not prevent or reduce the risk of concussion.

Learn more about fitting specific helmets for various sports.

Are there exercises to help decrease the chance of concussion?

Here are two articles about exercises to help decrease the chance of concussion:

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