Fact or Myth: A Concussion Series

Jana Raisner, Student Physical Therapist (SPT)
PSA Ratings: BA, RG

February 1, 2018
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Concussion is a topic that has flooded the sports news world. Several years ago the National Football League (NFL) was sued millions of dollars for disregarding the seriousness of concussions. The National Hockey League now has trained “concussion watchers” in arenas to pull players out of the game if suspected of having a concussion. The New York Times recently highlighted a study published which diagnosed Chronic Traumatic Encephalopathy (CTE), a debilitating neurodegenerative disease in 111 out of 112 NFL players tested after death (New York Times, 2017). What does this all mean? What do we need to know to ensure we are maintaining a safe and healthy environment for our skaters? U.S. Figure Skating and the Professional Skaters Association have taken a serious, thorough approach to providing concussion education to coaches. This series on concussions will build upon current education, cover facts and myths regarding concussions, decipher the latest research, and provide suggestions on how as a profession we can continue to build concussion awareness and safety.

My background in concussions dates back to my first concussion from a skating accident in 2009. I was at practice and slammed head first on the ice and lost consciousness. I was taken to the hospital on a stretcher and was told I would be “fine” in a few days. A few days turned into two years of full blown, debilitating Post-Concussion Syndrome that took over my life including six months of short-term memory loss and a medical leave from college for over a year. This May 2018, I will be graduating from the Mayo Clinic School of Health Sciences with my Doctorate in Physical Therapy and am pursing further education to specialize in concussion rehabilitation and sports medicine. Over the last two years studying at the Mayo Clinic I have been part of concussion research in ice hockey as a research assistant. The Mayo Clinic is part of a group of researchers trying to diagnose concussions with a blood test and better understand the physiological effects of concussions on the brain. Just when I thought my time in a rink was going to dwindle down in grad school, I signed on for more! It has been a privilege being surrounded by some of the best researchers in the world that make it their mission to better understand concussions.

Myth vs Fact

What is fact and what is myth regarding concussions? Here are a few common questions and misconceptions regarding the topic.

Concussion symptoms appear right away after a concussion.

Concussion symptoms do not have to appear right away. Symptoms can take up to several days and even weeks to fully appear. Due to the wide spectrum of symptom development it is very important to remove an athlete from play if they are suspected of having a concussion as they may not initially appear to have symptoms immediately (A Fact Sheet for Youth Sports Parents, 2017).

You have to hit your head to sustain a concussion.

A concussion can occur without a direct hit to the head and/or loss of consciousness. A concussion can occur from either a direct hit or from acceleration or deceleration of the head and neck; think whiplash forces. Acceleration and deceleration forces can cause concussion called coupe (primary impact) vs contra coupe (secondary impact) forces (Types of Neurologic Damage, 2010). Think about when your skaters fall on their tailbone or have a hard hit onto the ice such as tripping where they may not necessarily hit their head but they were falling at a high speed before impact with an abrupt stop.

Related image

Picture Reference: http://www.infocuseyecarenh.com/concussion-center.php?meta=What-is-a-Concussion&pid=26
If a coach suspects a concussion they are legally obligated to remove an athlete from play and the athlete must receive clearance from a doctor before returning to play.

As of 2013, 47 states have laws regarding removal of athletes from play if they are suspected of having a concussion with many states including responsibility of coaches to be educated to recognize signs and symptoms (Get a Heads Up on Concussion in Sports Policies, 2017). For example, in 2011 the state of Minnesota passed a law that requires any organization that organizes a youth athletic program to a) mandate that all officials and coaches receive concussion education to be renewed every three years, b) coaches have the responsibility to remove an athlete from play if the athlete demonstrates any behaviors or signs of a concussion and/or the coach suspects a concussion, and c) requires all athletes who are removed from play due to suspected concussion to have a health care professional’s signature for activity clearance before returning to play (Minnesota Concussion Law and Coach Training, 2017).

Take Aways:

  • Know the signs and symptoms of concussions. The Centers for Disease Control (CDC) has a free app: CDC HEADS UP available for mobile download that outlines everything you need to know about concussions. Another helpful resource is a USFSA concussion handout: http://www.usfsa.org/content/Concussion_Education_Information_9-21-13_-_BOD_reviewed_and_final_logo.pdf

  • Know your state coaching laws. Although there is no one site that lists all state laws, for example google, “Minnesota concussion laws and coaching” to determine your state laws. Check out the following site for a map highlighting states that have concussion laws in place. https://www.cdc.gov/headsup/pdfs/policy/headsuponconcussioninsportspolicies-a.pdf

  • Know your athletes. The better you know them and their personalities, the better you will be able to detect changes in mood, if they are having difficulty following directions and/or just don’t appear to be acting like themselves.

  • Educate athletes, parents, fellow coaches and rink staff. The more conversation, the better to provide awareness and to have a plan in place if a concussion occurs at your rink. The CDC’s website www.cdc.gov/concussion provides great resources specific for parents, coaches and health care providers that you can print off and hand out at your rink.

  • Have the athlete seek a medical provider who has further training in concussion assessment and management to get direct care as quickly as possible. Returning to play and physical activity too early can lead to the dangerous potential of suffering another concussion before the athlete is completely healed. There is a potential risk of death from a second serious impact to the head called Second Impact Syndrome (A Fact Sheet for Youth Sports Parents, 2017). 

Education is the biggest tool in the toolbox to both maintain a safe environment for skaters but also ease fears regarding the topic. As a leading researcher in concussion research Dr. Jeffrey S. Kutcher says, “If in doubt, sit them out.” The next part of the concussion series will highlight current concussion research and how it impacts the future of concussion safety and medical management.

The views expressed in this article are my own and do not reflect the views of the Mayo Clinic.  


A Fact Sheet for Youth Sports Parents. (2017). Retrieved December 27, 2017, from https://www.cdc.gov/headsup/pdfs/youthsports/parents_eng.pdf

Get a Heads Up on Concussion in Sports Policies. (2017). Retrieved December 27, 2017, from https://www.cdc.gov/headsup/pdfs/policy/headsuponconcussioninsportspolicies-a.pdf

Minnesota Concussion Law and Coach Training. (n.d.). Retrieved December 27, 2017, from http://www.healtheast.org/concussion/mn-law-training.html

Types of Neurologic Damage. (2010). Retrieved December 27, 2017, from http://www.northeastern.edu/nutraumaticbraininjury/what-is-tbi/types-of-damage/

Ward, J., Williams, J., & Manchester, S. (2017, July 25). 111 N.F.L. Brains. All But One Had C.T.E. Retrieved December 27, 2017, from