“When can I play again?” Research broadens timeline of concussion recovery for high school athletes

July 15, 2021

High school athletes are taking longer to return to sport following concussions, according to research from Michigan State University. The findings are an important element of keeping athletes safe.

“We’ve seen in previous research that many high school athletes—almost 50%—have lied about symptoms because they don’t want to miss playing time, don’t want to let their team down,” explained Tracey Covassin, lead investigator and Department of Kinesiology professor.

Analyzing data from nearly 16,000 concussions reported during the 2015-16 through 2018-19 academic years in Michigan, the scholars found the median time to return to sport was 11 days. Over the time studied, the median time to return to unrestricted sport increased from 10 days in 2015-16 to 12 days in 2018-19.

The findings, published in the Journal of Athletic Training (JAT), establish more realistic timelines for when athletes can return to sport, widening the range of what may be considered “normal.”

Yet, the scholars emphasize, it is important that each athlete and concussion be treated individually—not based off general statistics. For example, nearly 30% of athletes were not cleared for unrestricted return to play 14 days after their injury, and 6.5% took 28+ days before returning. A wide range is normal, the scholars say in their paper, “particularly for younger athletes whose brains are still developing.”

“Each concussion, each athlete is completely different,” Covassin added. “What might take one athlete 10 days to recover from will take another athlete a month. As athletic trainers, we don’t want to clear individuals who aren’t ready to go back into their sport. You don’t want an individual even a split-second too slow. That could mean the difference between getting hurt or not getting hurt.”

The invisible injury

Covassin is a noted leader in the field of sport-related concussions (SRCs). She was recently named one of the top-10 most cited researchers on sport-related concussions in the past decade (2010-19) by JAT. (Alumnus Anthony Kontos, M.S. ’95 (Physical Education & Exercise Science) and Ph.D. ’00 (Kinesiology), was also amongst those named.) Specifically, Covassin is known for examining the differences in how genders respond to concussions. Most scholarly research during 2010-19 was dominated by analysis of male-dominated sports; Covassin’s work addressed that gap.

See one example of her work: Female and younger athletes take longer to overcome concussions (2012)

Her February 2021 research—co-authored by MSU Kinesiology Ph.D. alumni Abigail Bretzin (’19), Erica Beidler (’16) and Jessica Wallace (’15)—examined females and males and 28 sports that are part of the Michigan High School Athletic Association. It is amongst the first to analyze that breadth of sports across an entire state, building upon previous work from other researchers that had smaller sample sizes or included data more than a decade old.

The improved knowledge of when athletes might return to sport could alleviate some of the pressure athletes feel about returning to the field. Unlike other injuries—say, a broken leg where bruising or swelling is apparent—concussions could be described as an “invisible injury,” says Covassin. Athletes may feel judged by peers for saying they have a concussion or concussion symptoms because the signs aren’t as noticeable. Instead, athletes may ignore or hide the symptoms, which can increase risk for secondary concussions and, in rare cases, permanent brain damage or death. Covassin said she hopes sport stakeholders realize the importance and seriousness of the injuries.

“Athletes need to take concussions seriously and report any symptoms they may have. They need to understand the warning signs of concussions and the dangers of playing with a concussion,” she explained. “We want people to be educated about the importance of taking the time needed to coming back to full health before returning to the field.”

Hear more from Covassin in this 2014 video on concussion knowledge, how concussions impact female athletes and more:

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