For the last few years – essentially since I did months of research on the sport for my book That’s Gotta Hurt: The Injuries That Changed Sports Forever – I have come to the conclusion that there is really no way to completely eliminate concussions or subconcussive blows in football. That belief doesn’t change my attitude that we must do what we can to decrease the risk. For that reason, I have been supportive of the NFL and NCAA’s efforts recently. I discuss why these rule changes to try to decrease concussions are so important, based on some new research studies about repeat concussions and immediate removal from play, in my latest newspaper column.

The NFL and NCAA have adopted a number of rule changes this offseason – fair catches on kickoffs inside the 25-yard line and penalizing players for lowering the head when tackling – to try to decrease concussions in football. Several recent scientific studies highlight why these changes are so important.

Repeat concussions can cause long-term brain damage and other health issues

Repeat concussions within 24 hours stops the brain’s repair mechanisms

Researchers at the National Institute of Neurological Disorders and Stroke at the National Institutes of Health appear to have discovered why an athlete who suffers repeated concussions could struggle with symptoms for months and even have permanent brain damage.

Also read:
Is a radical new football helmet design the answer to preventing concussions?

Normally when we suffer a concussion, many of us will have damage to the blood vessels in the connective tissue that lines the brain. The contents of the blood vessels can leak out, potentially damaging the brain cells underneath this connective tissue. Fortunately, for most people, the damage to the blood vessels repairs itself over several weeks.

In a study using mice, the NIH researchers found that a second brain injury within a 24-hour period prevented the normal regeneration of these damaged blood vessels. This interruption of the brain’s repair process might explain athletes’ post-concussion syndrome. These athletes can experience headaches, dizziness, sensitivity to light and nausea for months.

Repeat concussions often occur within 10 days of the initial trauma

We know that many athletes who experience repeat concussions do so within a short period of time from the initial trauma. The NCAA Concussion Study of 2905 college football players found that 92% of repeat concussions occurred within 10 days of the initial concussion.

These repeated concussions can take a tremendous toll, not just at the time of trauma, but years later.

The long-term effects on health of multiple concussions

Zachary Y. Kerr, Ph. D, MPH and other researchers studied 204 football players who played college football between 1999 and 2001 but never went on to play at the professional level. Athletes with a history of three or more concussions had worse overall health scores and worse indicators of mental health almost two decades later. In addition to the poorer health scores, which were on average worse than the U.S. population, these multiply concussed athletes were more likely to have moderate or severe depression and alcohol dependence.

Also read:
New research aims to advance our understanding of CTE and concussions

What about return to play after a concussion?

Allow me to be cynical for a minute. Maybe you don’t care about what a second, or third, concussion means for the healing of your son or daughter’s brain. Maybe you don’t care about their long-term health.

You just want him or her to play. “The playoffs are starting. He needs to play,” you might argue. “The team can’t win without my daughter,” you might believe.

For you win-at-all-cost parents, here’s your reason to hold out your kids after a concussion. They will return to play faster.

Athletes immediately removed from play after a concussion return to sports faster

Researchers from 25 collegiate institutions and military service academies studied athletes in 18 sports. The physicians treating the concussed athletes were asked two questions. Did the athlete immediately report the injury? Was the athlete immediately removed from play?

If the answer to both questions was yes, then the concussed athlete was labeled immediate removal of play. Sadly, about two-thirds of the athletes fell into the delayed removal from play category.

The athletes who reported their injuries and who were immediately removed from play missed less time from their sport (about three days less) and had a shorter duration of symptoms than the delayed removal athletes. The immediate removal athletes also had a lower risk of having recoveries that took 14 or 21 days or more.

Also read:
The risk of lower body injuries increases after concussions

Take home message about repeat concussions and immediate removal from play

These studies unquestionably show why the steps taken by the NCAA and NFL are necessary. We must absolutely take efforts to decrease the incidence of concussions athletes suffer. It also shows, though, that parents and coaches need to understand that athletes must be removed from play immediately after a concussion – no matter what.

Note: A modified version of this article appears as my sports medicine column in the April 26, 2018 issue of The Post and Courier.


Second concussion in quick succession interrupts brain’s ability to repair damage, finds study. Alex Matthews-King. Independent. April 16, 2018.

Alteration to football kickoff rule approved. April 13, 2018.

Kerr ZY, Thomas LC, Simon JE, McCrea M, Guskiewicz KM. Association Between History of Multiple Concussions and Health Outcomes Among Former College Football Players: 15-Year Follow-up From the NCAA Concussion Study (1999-2001). Am J Sports Med. April 1, 2018.

NFL institutes 15-yard penalty, possible ejection for lowering head to make hit. By Kevin Seifert. March 28, 2018.

Asken BM, Bauer RM, Guskiewicz KM, McCrea MA, Schmidt JD, Giza CC, Snyder AR, Houck ZM, Kontos AP, McAllister TW, Broglio SP, Clugston JR; CARE Consortium Investigators, Anderson S, Bazarian J, Brooks A, Buckley T, Chrisman S, Collins M, DiFiori J, Duma S, Dykhuizen B, Eckner JT, Feigenbaum L, Hoy A, Kelly L, Langford TD, Lintner L, McGinty G, Mihalik J, Miles C, Ortega J, Port N, Putukian M, Rowson S, Svoboda S. Immediate Removal From Activity After Sport-Related Concussion Is Associated With Shorter Clinical Recovery and Less Severe Symptoms in Collegiate Student-Athletes. Am J Sports Med. March 1, 2018.