New guidelines aim to improve student-athlete safety

Today, the NCAA and College Athletic Trainers’ Society, prominent medical organizations, college football coaches, administrators and conference commissioners released three inter-association guidelines to improve safety for college student-athletes.

Grand alliance latest step in efforts to understand concussion

The partnership between the NCAA and the Department of Defense, launched during the White House Healthy Kids and Safe Sports Concussion Summit, builds upon research initiatives the NCAA has funded for the last 15 years.

NCAA, DoD launch concussion study

The NCAA and U.S. Department of Defense launched a $30 million initiative to enhance the safety of student-athletes and service members, announced during the White House Healthy Kids & Safe Sports Concussion Summit.

Psychological Aspects of Sports Concussion

It is hard to imagine that a sports-related concussion (SRC) or mild traumatic brain injury (mTBI), or any event that triggers significant physical and cognitive symptoms and changes from normal functioning, would not produce some emotional or psychological reactions.  However, most of the focus in SRC management has been on tracking physical based symptoms (e.g. headache, balance problems, sleep disturbance/fatigue) and neurocognitive status (e.g. processing speed, attention/concentration, learning/memory) over time until the individual returns to baseline or asymptomatic status.  Emotional or psychological aspects, while seen as important factors in prolonged/persistent post-concussive syndrome, have not been discussed or investigated at the same level as the other symptom areas.

Emotional and psychological aspects of SRC can emerge related to a student-athlete’s response to injury and/or their response to recovery. Responses to injury typically produce a sense of loss (loss of control, loss of skills, loss of normalcy), a sense of vulnerability or fear, and anxiety/worry. Student-athletes often describe initial symptoms as “feeling off” or “not like myself,” which can be disconcerting.  In some instances, depressed mood or changes in behavior emerge as a direct result of the concussion in the acute recovery phase and can be related to fatigue.  Emotional and psychological responses play a crucial role in the athlete’s recovery (Mainwaring, Hutchison, Camper & Richards, 2012); these responses can include depressed mood, anxiety about the future, re-injury fears, frustration or anger (especially if symptoms persist beyond their expected time frame or have impacted their athletic career), sense of loss of team role or identity as an active and contributing student-athlete, significant disruption in social network and negative impact on academic pursuits.  After a SRC, some athletes are told by providers to physically rest and have “brain rest” (cognitive rest), which may be appropriate in the initial week of recovery, but can have harmful effects later in recovery.  Unfortunately, the terms “brain rest” or “cognitive rest” are not well-defined by providers and student-athletes have often understood it to mean “don’t think.”   For some, this prescription creates a fear of thinking and the belief that thinking or cognitive activity will harm their brain.  This is similar process to the development of a fear of movement (kinesiophobia) in pain patients, which can further restrict activities (Schmidt, 2003).  Removal from, or lessening of, academic demands may be appropriate for a period of time for some student-athletes, but the stress of falling behind and then having to make up and keep up with school assignments can often be significant and make its own contribution to symptoms.

The emotional symptoms that emerge from SRC can prolong recovery and often reflect  predisposing or premorbid factors. These factors can include prior depression or anxiety disorders, traumatic stress history, prior head injuries or other neurological vulnerabilities, learning issues, hypervigilance or somatic focus, or personality characteristics or disorders (Silverberg & Iverson, 2011).  Psychological factors associated with prolonged or persistent post-concussive symptoms include ineffective and maladaptive coping styles, sleep disturbance often due to mental activation, anxiety and stress/rumination, nocebo effect (adverse effects created or maintained by  negative expectations (Hahn, 1997; Scudellari, 2013)) and other expectation effects, and family or social network/support problems. Since the primary tool in the medical management of SRC involves tracking symptoms over time, one must wonder if focusing on symptoms on a daily or regular basis produces hypervigilance to symptoms and can result in reinforced illness behavior and iatrogenic effects resulting in prolonged post-concussion symptoms. 

Symptom checklists for concussion are not specific to this condition only.  Endorsement of symptoms may reflect other conditions or factors and occur to some degree in non-concussed individuals. These symptom checklists or rating scales are typically used as a general trending tool in recovery, but are largely reflective of self-perceived severity with highly individualized anchor points: are student-athletes rating the symptoms as an average over time since the last appointment or their worst experience of the symptom in the interval, or some other calculation?  Psychological and emotional factors, such as being an amplifier/maximizer or minimizer of symptoms, can be strong influences on these symptom ratings and need to be considered when reviewing the ratings during recovery.

Following a SRC, neurocognitive testing results often reflect a decline in certain cognitive areas for a period of time, which can be concerning to athletes and create focused attention to any and all cognitive inefficiencies.  In some instances, normal range inefficiencies are seen as evidence of ongoing SRC symptoms and/or slow recovery, which produce more stress and perpetuate the idea of and concern for continued brain-based injury.

Recognition that post-concussion syndrome is best managed in a multidisciplinary approach (NCAA Sport Science Institute) is crucial in being able to address these prolonging factors. While post-concussion syndrome and neurocognitive symptoms can initially be determined by the concussive event, at some point in time, these symptoms may become more maintained or prolonged by non-brain-based factors (or a combination of factors). Continuing to discuss symptoms as concussion-related some months post injury may perpetuate a brain injury focus which can contribute to activation of prolonging factors, a greater sense of disability and longer recovery times. Ideally, management and treatment of SRC should include opportunities to evaluate/address psychological or emotional factors or responses, which are likely activated in student-athletes to varying degrees.  As a member of the sports medicine team, clinically trained sport psychologists have the expertise to provide support to these injured student-athletes and address both their responses to injury and recovery, and be helpful in dealing with maladaptive coping strategies and recalibrate expectancies. The clinical sport psychologist can provide support in dealing with temporary or extended challenges to identity, athletic identity, self-esteem, and future plans and goals. These interventions often provide opportunities to deal with the fear of reinjury, address potential concerns over long-term consequences of concussions, and add to their general problem solving and resilience skills.  

The depression and anxiety that can emerge in recovery may track positively with the improving physical symptoms in many instances, but it may be important to assess and address these emotional dimensions independently, as the concussion experience may trigger other issues. Application of cognitive-behavioral therapy interventions for persistent post-concussion syndrome have shown positive results, with early brief intervention reducing prolonged recovery (Snell, Surgenor, Hay-Smith & Siegert, 2009). Components seen as effective include education about post-concussion symptoms, reattribution of  these symptoms to benign causes, reassurance of favorable prognosis, and gradual resumption of pre-injury activities (Mittenburg, Tremont, Zielinski, Fichera & Rayis, 1996; Mittenburg, Canyock, Condit & Patton, 2001).

It is important to recognize the role that psychological and emotional factors play in the response to injury and the course of recovery in SRC.  While the initial focus may be on physical based symptoms and reaching a physiologically-based return to play status (e.g., exertion without symptoms, game level stamina), psychological and emotional factors can be crucial in understanding and managing the student-athlete as they recover cognitively and emotionally, and return to pre-injury levels of performance.  Clinical sport psychologists can play an important role in the management of SRC. They have the expertise to assess and intervene and be an integral part of the  student-athlete’s recovery..


Hahn, R. (1997)  The Nocebo Phenomenon:  Concept, Evidence and Implications for Public Health.  Preventive Medicine, 26, 607-611.

Mainwaring, L., Hutchison, M., Comper, P. & Richards, D. (2012) Examining emotional sequelae of sport concussion.  Journal of Clinical Sports Psychology, 6(3), 247-274.

Mittenburg, W., Tremont, G., Zielinski, R., Fichera, S. & Rayls, K.  (1996) Cognitive-Behavioral Prevention of Postconcussion Syndrome.  Archives of Clinical Neuropsychology, 11(2), 139-145.

Mittenburg, W., Canyock, E., Condit, D. & Patton, C.  (2001)  Treatment of post-concussion syndrome following mild head injury.  Journal of Clinical and Experimental Neuropsychology, 23, 829-836.

Schmidt, A. (Oct 2003)  Does ‘mental kinesiophobia’ exist?  Behavior Research and Therapy, 41(10), 1243-1249.

Scudellari, M. (July 1 2013)  Worried Sick.  The Scientist Magazine (

Silverberg, N. & Iverson,G. (2011) Etiology of the post-concussion syndrome:  Physiogenesis and psychogenesis revisited.  NeuroRehabilitation, 29, 317-329.

Snell, D., Surgenor, L., hay-Smith, E. & Siegert, R. (2009)  A systematic review of psychological treatments for mild traumatic brain injury:  An update on the evidence.  Journal of Clinical and Experimental Neuropsychology, 31(1), 20-38.

About David Coppel, Ph.D.

Dr. David Coppel is a Professor in the Department of Neurological Surgery and the Director of Neuropsychological Services and Research at the University of Washington Sports Concussion Program, located at both Harborview Medical Center and Seattle Children’s Hospital. He works as a Clinical Psychologist, Clinical Neuropsychologist and Sport Psychologist in his current positions.  He is a Clinical Professor in both the Department of Psychiatry & Behavioral Sciences and the Department of Psychology at the University of Washington. Since 1996, Dr. Coppel has been the Consulting Neuropsychologist and Clinical/Sport Psychologist for the Seattle Seahawks. In his work at the Sports Concussion Program, he provides consultation regarding sports concussions to a number of high school, college and professional sports teams. Over the past 30 years, Dr. Coppel has specialized in clinical sport psychology and performance psychology and provided consultation to athletes, performers, and coaches at the amateur, collegiate, Olympic, and professional levels of competition.

The Importance of Training the Head and Neck

The Centers for Disease Control and Prevention (CDC) defines mild traumatic brain injury (MTBI) – which is used interchangeably with the term concussion – as a complex pathophysiologic process affecting the brain, induced by traumatic biomechanical forces secondary to direct or indirect forces to the head. A concussion or MTBI can be caused by a blow or a jolt to the head or body that disrupts the function of the brain.

There are methods for lowering the risk and reducing the number of sport-related concussions across America. Some of the factors are return to play, rules changes, the number of exposures, skill development, protective equipment and strength training to lower subconcussive forces. All of these considerations play a part in abatement of concussion. Exclusion of any one item affects the safety of the student-athlete. Each factor must be reviewed by the professional who, by using assiduity and diligence, can and will have a positive impact on risk.

Preventative sports medicine is the hallmark of any strength and conditioning program. The first goal of a professional is to develop effective and practical ways to reduce the number of sports-related injuries.

In the 1970s, collegiate programs began introducing strength training into their athletic programs to enhance performance as well as reduce injuries. There was very little research on the subject of weight training and athletics and many misnomers about strength training in general. At the time, the majority felt strongly that the use of barbells and strength training devices would inhibit athleticism by bulking and stiffening the athlete. Women, in general, had a strong fear of becoming too muscular. Educators worked to dispel those fears and strength and conditioning programs are now commonplace throughout athletics. Though some wrongly conceived beliefs still linger today when it comes to training the musculature associated with the cervical spine.

The benefits of muscular development are far greater than initially purported since the inception of strength training into intercollegiate athletics. One of the important functions of strength training has become the development of the muscle and tendon as a unit. The muscle-tendon unit attenuates and dissipates force. Developing a strong musculoskeletal system is what is needed to protect joints and reduce injuries. This attenuation and dissipation of force is not exclusive to particular joints in the anatomical system.

Dawn Comstock, associate professor of epidemiology at the Colorado School of Public Health, collected data on 6,704 student-athletes in six sports: boys' and girls' soccer, basketball and lacrosse. Her results indicated that for every pound of improved neck strength, an individual reduces his or her concussion risk.

Dr. Comstock from her years of injury surveillance points out the primary mechanism for concussion injury is athlete-to-athlete contact. The researcher then asked, "Did the athlete see the blow coming?" And she found that for the athletes who saw the blow coming – those who had a chance to activate their neck muscles – experienced less severe concussion.

The attenuation and dissipation of force and bracing before impact by activating neck muscles can lower subconcussive trauma. This is a great reason for training the musculature that moves the neck and supports the head.

There are many more reasons for an athlete to train this region of the anatomy. ‘Where the head goes the body will follow’ is an athletic axiom that coaches teach. Stand straight, place your fingers lightly on the nape of your neck. Without moving your head quickly move your eyes left and right. You will feel the musculature in your neck begin to contract. The eyes are not connected to the neck muscles but the brain is preparing the body for movement. Like our limbs it is important to move the head quickly. Training the head and neck will enhance performance.

The respiratory system’s process of inspiration and expiration involves much more than the diaphragm and the internal and external intercostal muscles. The scalene muscles in the neck are involved in almost every breath we take. The platysma and sternocleidomastoid are involved in heavy breathing (See Figure 1). Injure or develop neck muscles and your body’s athleticism will be affected. 

Conventional wisdom suggests that strength training increases body mass index (BMI) in a positive way, but does it? BMI is a simplistic measure of body fat. It is calculated by dividing one’s weight in kilograms by the square of one’s height in meters. The derived results can then be compared to a chart of normative data provided by the National Institutes of Health (NIH). BMI is useful for the overweight and obese, yet it does have limitations. BMI may overestimate body fat in athletes and others who have muscular builds. The problem is this simple tool does not differentiate between fat mass and lean body mass. It has long been argued that heavily muscled, weight-trained athletes are healthy despite their BMI classification.

At issue is the athlete that increases muscle mass and vascularity significantly in all areas of the body but the neck region alters peripheral vascular resistance in an acute way. Peripheral resistance is a function of the internal vessel diameter, vessel length and blood viscosity. Having a large body and an undeveloped neck changes the force of the delivery system’s blood flow to the head.

The cervical spine’s associated musculature is regarded as an important proprioceptive organ for postural processes. The muscles are small with a high spindle density. You can think of this region as the hotbed of proprioception. Disturbances of gait can occur by interfering with, damaging, weakening or fatiguing the muscles of the head and neck. Training this region augments static as well as dynamic posture – our ability to balance.

The head and neck muscular system is a complex anatomical structure and has apparent muscle redundancy; that is, more head and neck muscle than degrees of freedom. It is been postulated that individuals exhibit a large variation of neck muscle activation strategies for accomplishing the same task intra individually, as well as between subjects. The health practitioner’s return-to-play protocol after a concussion, whiplash, nerve or muscle trauma must contain a measurable strength component to restore each muscle to normalcy, redressing this tendency to substitute by the injured athlete.

Head and neck muscles can be thought of as two distinct muscular units, the musculature that moves the head and the muscles that move the cervical spine. Each unit must be trained to maximize development and ongoing strength values collected. This aids in overall muscular fitness and post injury assessment in returning a student-athlete to their appropriate functional movement.

Injuries to the mouth, face and jaw are part of sport. Having a strong jaw helps in bracing, clenching against a mouth guard, and resisting the pull of the chin strap in helmets. Injured masseter muscles, strained temporalis, pterygoids, digastrics all must be rehabilitated and strengthened when damaged (See Figures 2 and 3).

To help lower subconcussive forces, protect the student-athlete returning to play, maximize performance and fitness, strength training of the head, neck and jaw must be inclusive when designing exercise programs.


Further Reading

·         Sean Gregory Neck Strength Predicts Concussion Risk, Study Says Time Sports 02.21.2013.

·         Robert Nash, Angus Barnett, Sally Burrows, Warren Andrews, Brendyn Appleby Can a specific neck strengthening routine reduce cervical spine injuries in a Men’s Professional Rugby union team? A retrospective analysis Journal of Sports Medicine  2013 12,542-550

·         Paul Steinbach Sports Injury Expert Dawn Comstock Talks Concussion Prevention Athletic Business; Apr 2013, Vol. 37 Issue 4, p11

·         Beeman SM, Kemper AR, Madigan ML, Duma SM Effects of bracing on human kinematics in low-speed frontal sled tests. Ann Biomed Eng. 2011 Dec;39(12):2998-3010

·         Bose D, Crandall JR., Influence of active muscle contribution on the injury response of restrained car occupants. Ann Adv Automot Med. 2008 Oct; 52:61-72.

·         Vaccaro AR, Klein GR, Ciccoti M, Pfaff WL, Moulton MJ, Hilibrand AJ Watkins Return to play criteria for the athlete with cervical spine injuries resulting in stinger and transient quadriplegia/paresis.Spine J. 2002 Sep-Oct;2(5):351-6.

·         Anita N. Vasavada, Barry W. Peterson, Scott L. Delp, Three-dimensional spatial tuning of neck muscle activation in humans Exp Brain Res (2002) 147:437–448.

·         Thomas J. Roberts and Emanuel Azizi The series-elastic shock absorber: tendons attenuate muscle power during eccentric actions, Journal of Applied Physiology August 1, 2010 vol. 109 no. 2 396-404.

·         Armstrong B, McNair P, Taylor D., Head and neck position sense. Sports Med. 2008; 38(2):101-17.


About Mike Gittleson

A pioneer in the field, Mike Gittleson spent thirty seasons as the Head Strength and Conditioning Coach for the University of Michigan’s football program. He was appointed the athletic department’s first strength and conditioning coach in 1978. Gittleson was recognized by the Professional Football Strength and Conditioning Coaches Society as the 2003 National Collegiate Football Strength and Conditioning Coach of the Year.

Gittleson maintained the overall training and conditioning of the football program in one of the finest facilities in the country. He developed a unique and scientific approach to Michigan’s conditioning program, tailoring each program to the individual player in order to provide the maximum physical output and the prevention of injuries.

A native of Manchester, N.H., Gittleson earned degrees from the University of New Hampshire (1975) and Plymouth State College (1977). He graduated summa cum laude with a 3.9 grade point average and was named the outstanding physical education student in his class at Plymouth State. Gittleson also lettered in three sports, football, wrestling and track and won the state weightlifting championship.

A Vietnam veteran, he later came to Michigan and completed a master’s degree in exercise science (1980) and earned the prestigious Paul Hunsicker Award as an outstanding graduate student at the University.

An adjunct lecturer in Sports Management and Communication for the Division of Kinesiology, Gittleson was honored with the distinction of becoming an “Honorary ‘M’ Man” in 1997

Do Female Athletes Concuss Differently than Males?

By: Brian Hainline, MD

Do Females Concuss Differently?

Do females concuss differently than males?

It’s a compelling question among concussion researchers. Despite the intrigue of this question, there is little media attention to this matter. The tendency of the media is to focus on football. The advantage of this column is that I can choose the topics that need to be communicated to a broader audience. Therefore, I am devoting this column to explore concussions in female athletes.

A female’s brain is different than a male’s brain. This is a statement of fact, not judgment. One difference in particular has to do with a female’s susceptibility to migraine between puberty and menopause. During the child-bearing ages, females undergo considerable hormonal fluctuation on a monthly basis in preparation for possible pregnancy. Estradiol in particular reaches peak levels as the uterus becomes prepared for possible embryo implantation, and then drops precipitously if no implantation takes place. Estradiol fluctuation is one of the primary culprits in driving migraine. Before puberty and after menopause, males and females suffer with migraine equally. During child-bearing ages, females are about four times more likely to suffer with migraine. Estradiol interacts specifically with the trigeminal vascular complex, which is an area of the brain that controls migraine pathophysiology.

Why do we care about migraine when discussing concussion in females? Because migraine and concussion share similar pathophysiological expressions. During a migraine aura (often experienced as visual hallucinations), there is an excitatory electrical phenomenon in the brain that is followed by an inhibitory electrical phenomenon. This inhibitory electrical phenomenon is known as ‘spreading depression.’ Spreading depression refers to waves of depressed electrical activity in the brain and has nothing to do with emotions, per se. Think of a pebble that is dropped in a still lake. There are observable waves that emanate from the epicenter of the dropped pebble, and these waves are conceptually similar to the spreading depression waves that occur during a migraine aura. As a result of the progressive inhibitory electrical spread, there is associated neurological dysfunction, ranging from visual loss to difficulty speaking to confusion to vertigo to loss of consciousness.

Scientists have also described spreading depression as an acute manifestation of concussion. Following an impact to the brain sufficient to cause a concussion, there are multiple areas of the brain that may develop spreading depression waves, and this may be an important contributing factor to concussion symptomatology. This also explains why concussion symptoms can worsen for hours following the inciting event. For female athletes during their child bearing years, there is a statistically increased likelihood that a female with migraine susceptibility will become concussed, and such females have a lower threshold to developing secondary spreading depression. In other words, females with migraine susceptibility are more vulnerable to developing worsened symptoms relative to their non-migraine counterpart. At present, the spreading depression hypothesis needs further scientific study; however, it is an intriguing explanation of male-female differences. Spreading depression may help to explain studies that demonstrate the following:

  • Female concussed athletes report more concussion symptoms than their male counterparts, including poor concentration, lightheadedness, increased fatigue, headache, and visual hallucinations such as seeing stars.
  • Female concussed athletes suffer with greater cognitive decline and slowed reaction time relative to males.
  • College female concussed athletes perform more poorly on BESS (Balance Error Scoring System) following concussion relative to males.

In addition to suffering with more concussion symptomatology, females have a higher rate of concussion compared to males when playing the following sports:

  • Soccer (2.1 x greater risk)
  • Softball versus baseball (up to 3.2 x greater risk)
  • Basketball (up to 1.7 x greater risk)

In self-report data that we will explore further in a future column, college female ice hockey players have the highest odds ratio of developing concussion, even when considering football, a male-only event. Thus, female athletes seem uniquely predisposed to suffering with more concussion and worsened concussion symptomatology relative to males. What is startling is that even in lacrosse, female athletes seem to suffer concussion at a similar incidence to males, but female lacrosse is not a contact sport, whereas male lacrosse is a contact sport.

Studies have also demonstrated that females have more injuries due to player-surface contact and player-equipment contact compared to males (males have more injuries from player-player contact compared to females). Females also may have a higher proportion of recurrent concussions compared to males. There may be factors beyond brain physiology that help explain these differences. One aspect of concussion is the biomechanical readiness of protecting the head from sudden acceleration-deceleration and rotational forces. From this framework, females may be at a disadvantage because they have less neck strength than males. This can translate into less ability to counteract mechanical forces that can cause head and neck acceleration-deceleration and rotation. Consider the following statistically significant difference in females compared to males when measuring head-neck strength components and concomitant acceleration forces:

  • Females have 25 percent less head-neck segment mass than males.
  • Females have 5 percent less head-neck segment length than males.
  • Females have 12 percent less neck girth than males.
  • Females have 50 percent less isometric neck flexor strength than males.
  • Females have 53 percent less isometric neck extensor strength than males.
  • Females have up to 44 percent greater head acceleration than males following contact, and have 10 percent greater head accelerations than males during non-contact.

We need to explore female-male concussion differences in more detail. Meanwhile, we all need to spread the word: yes, female athletes also suffer with concussion, and they may be uniquely predisposed to this neurological event.


  1. Yoshino A et al: Dynamic changes in local cerebral glucose utilization following cerebral concussion in rats: evidence of a hyper- and subsequent hypometabolic state. Brain Research 1991; 1:106-119.
  2. Hainline B: Migraine and other headache conditions. In Hainline B, Devinsky O (eds): Neurological Complications of Pregnancy, Second Edition, Philadelphia, Lippincott Williams & Wilkins, 2002, pp25-40.
  3. Lincoln AE et al: Trends in concussion incidence in high school sports: a prospective 11-year study. Am J Sports Med 2011; 39:958-963.
  4. Marar M et al: Epidemiology of concussions among United States high school athletes in 20 sports. Am J Sports Med 2012; 40:747-755.
  5. Broshek DK et al: Sex differences in outcome following sports-related concussion. J Neurosurg 2012; 116:856-863.
  6. Covassin T et al: The role of age and sex in symptoms, neurocognitive performance, and postural stability in athletes after concussion. Am J Sports Med 2012; 40:1303-1312.
  7. Colvin AC et al: The role of concussion history and gender in recovery from soccer-related concussion. Am J Sports Med 2009; 37:1699-1704.
  8. Tierney RT et al: Sex differences in head acceleration during heading while wearing soccer headgear. J Athl Train 2008; 43:578-584.

Tasked with a heady issue

Only weeks into his new role as the NCAA’s first chief medical officer, Brian Hainline roamed the halls at the 2013 NCAA Convention, convinced he would hear that concussions were the membership’s chief health and safety concern. To his...

NCAA funds study examining the long-term effects of concussions in sports

By Brian Burnsed

The NCAA has awarded a pair of leading concussion researchers a $399,999 grant, which will help subsidize a potentially groundbreaking study examining the long-term effects of head injuries in college athletes.

Kevin Guskiewicz, director of North Carolina’s Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center and Michael McCrea, director of brain injury research at Medical College of Wisconsin, are spearheading the research.

While numerous studies – including work by Guskiewicz and McCrea – have examined the effects of concussions immediately after they occur, a dearth of academic literature pertains to the chronic neurological effects of concussions and repetitive, sub-concussive head impacts, particularly among NCAA athletes. The public and athletes alike have grown increasingly concerned about the long-term impact of head injuries, but the void in understanding has been filled mostly by conjecture and anecdotal evidence, the researchers suggest. Guskiewicz and McCrea, however, seek to fill it with hard data by conducting examinations with former student-athletes involved in previous studies.    

“Clinical research has advanced our understanding of sport-related concussion and has driven evidence-based approaches to acute injury management and return to play guidelines,” the researchers wrote in their study proposal. “Recent concerns, however, focus on potentialchronic neurologic effects of concussion and repetitive head impacts in contact sports… This study represents the most comprehensive investigation of long-range neurologic health outcomes in former NCAA athletes.”

For this study, the researchers will draw upon the pool of NCAA student-athletes who took part in a previous NCAA-funded study. In 1999, Guskiewicz and McCrea embarked on “The NCAA Concussion Study”, which examined football players from 29 NCAA Division I, II and III schools. When findings were published in 2003, no other study had examined a larger pool of concussed athletes. Thanks to that study, Guskiewicz and McCrea already have a slew of data at their disposal, which they’ll be able to use alongside the new data they collect from many of the same athletes. That ability to track college athletes’ health over an extended window will be immensely beneficial, Guskiewicz and McCrea wrote, given that it will allow them to identify clear trends over time.

“They are the right investigators for this,” said NCAA Chief Medical Officer Brian Hainline. “They’re working with solid baseline data for which comparisons can be made, and they make proposals for cutting-edge neuroimaging biomarkers that will help shape the future of concussion diagnosis and management.”   

Through the first 18 months of the study, the researchers will conduct a health survey of 2,000 former student-athletes who took part in the first NCAA Concussion Study as well as other studies Guskiewicz and McCrea carried out through the late 1990s and early last decade. Based on their responses, that field will be whittled down to 120 respondents with varying levels of concussion exposure across an array of contact sports. That group will take part in physical evaluations, such as balance assessments, psychological surveys, genetic testing and neuroimaging studies, among others, at either researcher’s campus. Guskiewicz and McCrea believe that tracking these former student-athletes over such a lengthy period of time – they plan to study this group for years to come – and comparing them to data collected from retired NFL players will shed new light on the long-term effects, or lack thereof, of both concussions and repeated head impacts in college athletics.

“Our study will advance the science on the chronic effects of concussion and head impact exposure, while protecting the health of athletes and the future of NCAA sports,” Guskiewicz and McCrea wrote.


A concussion is a serious injury, so proper reporting, diagnosis and treatment are crucial. Student-athlete wellbeing is a priority for the NCAA and has been a key component of our mission for more than 100 years. The NCAA is a leader in evaluating the impact of concussions in sport and has produced research and best practices to mitigate the potential effects of head injuries. 

In partnership with the U.S. Department of Defense, the NCAA announced in May 2014 a $30 million effort to fund the most comprehensive clinical study of concussion and head impact exposure ever conducted, and issue an educational grand challenge aimed at changing important concussion safety behaviors in college sports and ultimately, the military. Over the next three years, the study will perform baseline assessments on more than 37,000 student-athletes, plus repeat assessments on any individual who suffers a concussion.  This landmark research will establish the natural history of concussion including risks, treatment and management.  The educational grand challenge, to be launched in September 2014, will seek to change the culture of concussion reporting and management among coaches, administrators and student-athletes. Combined with previous research funded by the NCAA, this initiative will develop resources for providing student-athletes with the best care possible.

NCAA member schools are a critical component of these efforts. Our campuses recognize the responsibility they have to care for their student-athletes. To empower campus personnel and others with the most up-to-date information on concussions, the NCAA provides detailed recommendations in its Sports Medicine Handbook Guideline 21—a publication that is available to every NCAA member school.  The NCAA also provides resources to raise awareness of concussions among student-athletes.

In addition to playing rules aimed at providing a safer playing environment, such as prohibiting helmet-to-helmet contact, the NCAA requires each member school to have a concussion management plan in place. These plans detail when a player should be removed from practice or competition and give guidelines for evaluation by a health care provider before returning to play. If a student-athlete shows signs of a concussion, he or she is not permitted to return to play the same day of the injury.



Hainline and Division III Presidents Council discuss array of health and safety issues

By Brian Burnsed The Division III Presidents Council and NCAA Chief Medical Officer Brian Hainline engaged in a spirited discussion of the proposed association-wide sport safety package legislation at the council’s Oct. 30 meeting in...


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