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The Psychological Impact of Concussions

Concussions have become one of the most concerning injuries in sports. The injury is a hot topic in the media and has sparked a great deal of new research showing not only short term but the long term effects of concussions, making this injury particularly unique. While we are hearing tragic stories of the long-term effects of concussions in professional athletes like NFL star Junior Seau or Pro Wrestler Chris Benoit, there has been a shift of focus on how we can prevent our youth athletes from suffering the same fate.

What makes concussions unique is the fact that they are considered an “invisible injury.” This is especially concerning for the younger athletes who are exposed to potential experiences that could cause a concussion. Research has shown that “Adolescents are at higher risk because of their developing brains. The high school athlete has a greater risk than the college athlete, and the college athlete a greater risk than the professional athlete” (Cleveland Clinic, Concussions). Interestingly, “Females participating in high school sports now have a higher incidence rate of sport-related concussions than do males” (Gessel et al., 2007; Powell & Barber-Foss, 1999; Covassin et al., 2003).

The physical causes and symptoms are well-documented in the Women’s Sport Foundation Research articles and can be found throughout this website. The more misunderstood and lesser known aspect of concussions is the psychological and emotional classifications and treatments. It’s important to understand that although concussions are often classified as “mild” because they are not life threatening, there are serious psychological and emotional consequences that occur during and post concussive incident.

Psychological/Emotional Consequences of Concussion

Higher Levels of Stress

  • Pain, change in routine, negative thoughts, feelings of isolation and frustration all lead to increase in stress

Threats to Personal Identity

  • What is the first question we ask?…”What do you do?”
  • Sport can be a way in which individuals identify themselves and when this happen it can cause confusion and stress

Loss of Confidence

  • Missing practice or training can lead athletes to feel behind or that they will not be able to return the same as prior to concussion

Fear of Getting Reinjured

  • Many athletes are fearful to return as they have lost confidence or that they are fearful of becoming concussed again

Higher Levels of Depression/Anxiety

  • Research shows that up to 27% of injured athletes experience clinical levels of emotional disturbance (Brewer, et al. 1999).

It is important to understand the recovery process is not just physical but psychological and emotional, as well. Many athletes experience emotions of guilt, shame, or social isolation following a concussion. Researchers have found that, “injured athletes express some of the common reactions seen in trauma victims outlined by the United States Department of Veterans Affairs and include: fear, anxiety, avoidance, anger, irritability, grief, and depression (Foa, 2005).

In many cases these feelings are exacerbated in concussion situations as these athletes can’t participate in physical rehab. For example, someone with a torn ACL can be active in the training room and weight room and continue to rehab around teammates. However, in a concussion situation, athletes cannot participate in any physical treatment and in many cases feel that their injury is not “worthy.”

Former Northwestern soccer player, Anna Cassell, explains that “unfortunately, the harm of these concussions extend beyond the field. I suffered severe headaches, bouts of anxiety and depression, and balance problems, which all contributed to my falling weeks behind in my pre-med studies.”

Pressure to Return to Play

In many cases, concussed athletes often feel pressure to return to play as soon as possible. This can often come from a variety of sources including, coaches, parents or teammates. However, the recovery period is vital and can have long term impact on the brain if proper time is not given. This recovery time in many cases is not considered acceptable in comparison to visible injuries. For example, we would never encourage a player with a broken leg to begin running within a week, however, the same standard is not always applied to concussed athletes.

We have to be aware that this pressure to get back in the game has an effect on the athlete during recovery. This can lead to irritation or impatience for athletes as Elena Delle Donne, WNBA player stated, “It was pretty frustrating since you don’t know exactly when you’re going to be able to come back. If you don’t pass the tests, you get pushed back a day.” By adding more negative emotions to the situation, the recovery process is often overlooked or worsened. In addition, the added pressure an athlete may feel can lead to lack of motivation and resentment.

Social Support in Rehabilitation

Many concussed athletes are told to limit tv, no participation in training/practice, reduce screen time, avoid exertion of daily activities, and in some cases avoid team travel or gatherings. With this prescription for recovery, many athletes begin to feel isolated and lonely. Athletes, who are used to training daily and interacting with teammates, quickly have a new routine or lack of routine. Therefore, finding social support in teammates who have experienced similar injuries, having a good relationship with medical team, or seeking out a sport psychology consultant is important. In fact, it has been reported that athletes who have a strong social support group have followed their injury recovery plan better, experienced higher levels of motivation, and applied a positive mental attitude in the rehabilitation process.

Take Away Message

While sports are becoming more intense at younger levels it’s important that the awareness and prevention of concussions also continues to grow. It is much easier for an individual with a concussion to sweep it under the rug or return to play too quickly, but there are clear psychological consequences to this and getting more serious in youth sports. Allowing players to take the appropriate time to recover from a concussion is essential not only physically but psychologically. It is essential that we understand and cultivate awareness of concussions and the importance treating the injury as just that- an injury and not just a bump to the head where you are encouraged to bounce right back.

Kat Scardino, M.Ed. and Devin Markle, Co-Directors of Athlete Development at Sports Academy, are members of the WSF Digital Contribution Team.

The content provided for this article has been approved by the Women’s Sports Foundation.