Long-Term Impacts of Concussions: What Athletic Trainers Need to Know

Concussions are a critical concern for athletes, families, and staff in most sports.

Athletic trainers play a key role in identifying and managing concussions, as well as educating athletes, families, and staff about the possible long-term impacts of concussions. The cause, severity, frequency, and management of the head injury will determine the long-term effects of a concussion, which can range from minimal to extreme.  

Related: Management of Sports-Related Concussions: Staying Ahead of the Game 

Understanding Chronic Traumatic Encephalopathy (CTE) 

CTE is a neurodegenerative disease associated with repeated concussions and head trauma. It is characterized by the accumulation of tau protein in the brain (McKee, 2015), which can disrupt normal brain function. 

Symptoms of early CTE include mood changes, irritability, depression, and difficulty concentrating. As the disease progresses, symptoms can worsen, leading to cognitive impairment, memory loss, and severe emotional and behavioral changes. 

Although the clearest way to prevent CTE is to avoid a concussion, that is not aways possible and therefore other measures include providing enough time for recuperation between injuries, and immediate care if a head injury occurs. 

The National Athletic Trainers Association offers this helpful graphic to check for immediate signs of concussion. It can help athletic trainers and athletes determine whether it is safe to continue to play. 

Understand post-concussion syndrome (PCS) 

PCS is neurological condition that persists after a concussion. Symptoms include headache, dizziness, fatigue, light sensitivity, sleep disturbance, and concentration difficulties. Symptoms may persist for weeks or even months after the initial head injury. 

To address PCS, the athlete should rest, and the athletic trainer should develop a stepwise return-to-play protocol (RTPP) with the help of medical professionals. 

Return-to-play protocols (RTPP) 

A RTPP is a requirement for an athlete to return safely to practice and play following a concussion. A RTPP is a step-by-step plan to safely allow the brain of an athlete to heal prior to full return to sport. At a minimum, the RTPP requires that each stage of recovery be complete with no recurrence of concussion symptoms. Early return to the play of an athlete can increase the risk of re-injury and negative long-term consequences.  

Watch for neurocognitive decline 

Long-term neurocognitive decline due to concussion is characterized by problems with memory, executive function, and processing speed. Neurocognitive decline is especially prevalent when there is inadequate time for recovery between concussions. 

Cognitive impairment affects the daily livelihood of an athlete and may impact work, school, family life, and socializing. The role of the athletic trainer following concussions extends beyond practice and play to help make sure that the needs of recovery are met outside of sport. Athletic trainers should play a supporting role to facilitate accommodation, such as extended time on tests, quiet classroom space, and reduced workloads to help an athlete recover. 

Be aware of increased risk of further injury 

When a head injury occurs, the brain is vulnerable. A second concussion before symptoms have resolved can lead to a fatal condition called Second Impact Syndrome (SIS). It is imperative that athletic trainers are aware of SIS and do not allow athletes to return to contact practice or play after a concussion until they have been symptom-free for a sufficient period and are cleared by a licensed medial professional to return to full sport. 

Monitor mental health 

Concussions and head injuries are associated with the development of various mental health disorders, like major depression, anxiety, and post-traumatic stress disorder. The stress associated with dealing with an injury, possible cognitive decline, and loss of sport can make symptoms worse. Athletic trainers should recognize the signs of mental health disorders and refer athletes to appropriate mental health professionals when needed. Early intervention and support are vital to prevent tragedy and facilitate best outcomes. 

Continuing education and awareness 

Athletic trainers need to be up to date about the latest research on concussion management strategies, diagnostic tools, and prevention measures. The science of concussions is constantly evolving, and athletic trainers are encouraged to take courses related to concussion management frequently. 

Athletic trainers play a vital role in the immediate and long-term management of concussions. It is important that they recognize the potential long-term effects of concussion, including neurocognitive decline, mental health concerns, and increased risks for further injury. By following best practices in concussion management, advocating for appropriate recovery, and educating athletes, families, and staff, athletic trainers have the potential to mitigate the long-term effects of concussion and protect the health and well-being of athletes. 

References 

• McKee AC, Stein TD, Kiernan PT, Alvarez VE. The neuropathology of chronic traumatic encephalopathy. Brain Pathol. 2015 May;25(3):350-64. doi: 10.1111/bpa.12248. PMID: 25904048; PMCID: PMC4526170. 
• Concussion 101, C1_NATA_OCT23 .indd