Concussions: Are High School Sports Worth the Risk?

Sports can be a positive addition to the high school experience — molding an adolescent and their skills. But is participating in high school athletics worth the risk of concussion?

Participating in high school sports offers many benefits. Social experiences, building confidence, and teamwork skills are various ways young people may want to play sports. Moreover, it's simply fun. High school, for many kids, is about fitting in, and sometimes strapping on your soccer cleats is a way to build friendship and social acceptance. Nevertheless, participating in sports — especially contact sports — carries the possibility of injuries, including concussions. So, is popularity worth the risk?

A concussion is a type of traumatic brain injury (TBI) that occurs when the brain is shaken or jolted inside the skull due to a fall, blow to the head, a car accident, or any other head impact.

Concussions can cause a range of symptoms, including headaches, dizziness, confusion, memory loss, and sensitivity to light and sound. In some cases, a concussion can cause people to lose consciousness.

Treating a concussion typically involves both physical and cognitive rest until symptoms subside. This may include avoiding activities that require mental concentration or physical exertion, such as sports, work, and school.

However, repeated head impacts or concussions can have long-term effects on brain function and may increase the risk of developing specific brain-related chronic conditions.

For example, research published on March 16 in The Lancet Public Health found that professional outfield soccer players — not goalkeepers — had a higher risk of dementia. The study authors say that mild head impacts from heading the ball could increase the risk.

How common are concussions among high school athletes?

Reports estimate that 300,000 high school athletes experience a concussion each year. Moreover, the number of reported concussions among high school athletes increased between 2015 to 2017, with boys’ football, girls’ soccer, and girls’ volleyball associated with the most concussions.

In addition, a 2021 study found that six to 14-year-old youth tackle football athletes sustained 15 times more head impacts and 23 times more hard head impacts than flag football players during a practice or game.

Still, not all concussions are reported or diagnosed, so the actual number of high school students who experience concussions may be higher than these estimates.

What are the potential long-term effects of concussions?

While a concussion can cause immediate and noticeable effects, it can also lead to concerning issues long after it has occurred.

Briana Calcagno-Davi, Psy.D., a pediatric neuropsychologist at Staten Island University Hospital, told Healthnews:

"For approximately one week after the injury, many patients will experience some health effects, ranging from mild to severe depending on the severity of the injury. However, after a week, research has shown that symptoms can last for approximately 4 to 6 weeks for patients that experience a more moderate to severe injury or have underlying biological factors that increase the risk of symptoms."

Calcagno-Davi says that symptoms can fall into several categories, including but not limited to:

• Physical symptoms: headaches, nausea, fatigue, sensory sensitivities, visual problems, and balance problems.
• Cognitive issues: mental fogginess, difficulties concentrating, and difficulties remembering.
• Emotional symptoms: irritability, decreased sadness, nervousness, and increased emotionality.
• Sleep concerns: drowsiness, increased or decreased sleep, and trouble falling asleep.

"For a very small percentage, usually those who incur a more severe injury (e.g., lost consciousness, have associated amnesia, are vomiting shortly after, have confusion, etc.), their long-term health effects may last a little longer, with most feeling asymptomatic shortly after the typical 6-week mark," Calcagno-Davi explains.

In addition, research suggests that repeated concussions may lead to conditions such as:

• Chronic traumatic encephalopathy (CTE): CTE is a degenerative brain disease associated with repeated head injuries, including concussions, and can cause a range of symptoms, including memory loss, cognitive decline, depression, and mood swings.
• Post-Concussion Syndrome (PCS): PCS is another condition that can occur after a concussion. It can cause symptoms such as headaches, dizziness, fatigue, irritability, and difficulty concentrating that last for weeks, months, or even years after the initial injury.
• Cognitive Impairment: Multiple concussions are associated with an increased risk of cognitive impairment, including problems with memory, attention, and executive function.
• Emotional and Behavioral Changes: Repeated head injuries can also lead to changes in mood and behavior, such as depression, anxiety, irritability, and impulsivity.

In addition, individuals who have had multiple concussions may be more susceptible to future head injuries and may experience more severe symptoms with subsequent concussions.

How many concussions are too many?

"Typically, there are no major long-term health effects from 1 or 2 concussions. We become concerned when student-athletes have multiple concussions in too short of an interval of time," says Seth Stoller, M.D., Director of the Concussion Center at the Overlook Medical Center. "When this occurs, some patients can develop longer-term headaches — including migraines — and issues with attention, concentration, and memory."

Calcagno-Davi adds, "Unfortunately, there is no 'one size fits all' response [to this question]. For many people who experience more than one 'head injury' throughout their life, there will be little to no long-term impact. However, in more severe cases, there can be life-long implications."

Stoller says that "while there is no definitive number that we identify, it is the interval of time between two concussions that is most concerning. We absolutely must avoid having two concussions in less than 2 weeks [because] catastrophic injuries can occur."

Some schools disqualify athletes with too many concussions, but not all schools follow this protocol. Every medical professional has a different opinion — with many waiting long after healing time to others asking follow-up questions in the following days during concussion management.

"When a patient has more than 3 to 4 concussions, I typically advise them to avoid contact sports going forwards," Stoller says.

Are high school sports worth the risk of concussions?

Determining whether to participate in high school sports is a personal decision between parents and their children. It may also depend on the type of sport the child chooses.

Stoller says contact sports have a much higher risk of concussions than noncontact sports. However, he adds, "at a certain point when a student-athlete has multiple concussions, we advise this student and their parents that the risk of long-term brain health is not worth jeopardizing and position the student-athlete into a noncontact sport pathway."

"As a former high school varsity athlete, Staten Island All-star, and member of the Athletic Hall of Fame at Staten Island Academy, I feel that there are many benefits to playing sports. It provides students with social opportunities, improves their physical health, teaches them life lessons regarding responsibility, teamwork, and how to plan, can be a great source to expend extra energy, and overall is a very positive experience for many children and teens."

Briana Calcagno-Davi, Psy.D.

Therefore, Calcagno-Davi says, "as a pediatric neuropsychologist, my goal is never to remove children from the amazing benefits they can experience from participating in sports. My goal is to help inform parents, coaches, athletic directors, and athletes with the information and tools they need to continue participating in the safest way possible."

Ultimately, the decision to participate in high school sports should be made individually, considering the risks and benefits, the athlete's current circumstances, and their willingness to follow safety guidelines and take appropriate precautions to reduce the risk of injury.