Identifying a concussed athlete

How to identify a concussion during practice/game play

Concussion is mainly diagnosed through the symptoms that an athlete may report or through comparison with objective baseline testing measures, if available. If an athlete doesn’t report any symptoms, there are very few visual signs that spotters can look for that may indicate concussion.

Here are some of the common signs that spotters should look out for. As a parent, coach, or teammate you can watch for these too. Everyone should be a concussion spotter.

Ways to be a concussion spotter

1. Significant impact to the head or body

A concussion is caused by a hit to the head or elsewhere on the body (due to the force transmitted to the head). This could also include secondary contact with the ice or field. If you see a significant impact then you should suspect a concussion.

2. Loss of consciousness

If an athlete loses consciousness following an impact then it’s definitely a concussion. If they are unconscious for an extended period – more than 60 seconds – then they should be taken to an emergency department immediately as this may mean a more severe injury.

3. Lying motionless

You should suspect a concussion if a player is down on the field or ice, and does not move following an impact; they may be unconscious. This is sometimes accompanied by a fencing reflex or posturing. This is when a player’s arm is flexed or extended into the air for several seconds after a hit. The fencing response is a clear indication that the player is unconscious. Check out the examples in the video below.

4. Clutching the head or helmet

Grabbing the head or helmet following an impact can be an indication of a concussion.

5. Difficulty getting up, stumbling, incoordination, slowed movement or disorientation

In the example, you’ll notice that Chicago Blackhawks captain, Jonathan Toews, shows these symptoms following a huge hit. Keep in mind, any one of these signs after a hit could mean that the player suffered a concussion. 

 6. Blank or vacant stare

Does the athlete seem to be staring into space after the hit? Are they looking at you or right through you? Do they seem dazed and confused? A blank stare may tell you that they have a concussion. 

7. Inability to communicate, unable to respond to questions or slurred speech

Listen to how they talk. If an athlete cannot respond to simple questions or you don’t understand them following an impact, it’s likely they have a concussion.

8. Vomiting

If an individual is sick and vomiting following a big hit or impact, then this is another possible sign of concussion. In fact, vomiting after head trauma may be a sign of a more severe head injury and the athlete should be taken to the hospital immediately.

Recognize and remove!

The culture of sport and toughness is much more apparent at the professional level where the stakes are higher for the athletes. However, at all levels, we need to continue to take a stand and strive to improve the health and safety of athletes through proper concussion recognition and management. Remember, when in doubt, sit them out!

Understanding all the signs and symptoms of concussion is often the first step to proper concussion management. Early recognition and intervention by a licensed healthcare professional with concussion training has been shown to improve recovery time and patient outcomes.  All those involved in sports – teammates, opposing players, coaches, teachers, referees and more – should be a concussion spotter.


This article is not intended as a substitute for the medical advice of doctors and/or healthcare professionals. The reader should consult their physician and/or healthcare providers in matters relating to their health, and in particular, with respect to any concussion and/or symptoms that may require diagnosis or medical attention.

This article was adopted from the Completely Concussion Management Resource Portal.  Click here for more resources.

Photo by Jerry Yu on Unsplash.

Concussion Rates: What Sport Has The Most Concussions?

Concussion is a serious concern for all athletes, particularly for those involved in contact, high-speed or collision sports. These injuries have become a significant issue for certain sports. In fact, some contact sports, such as American or tackle football, are seeing a decline in registration and participation year over year.

But, what sport – or sports – has the most concussions? What sports have higher concussion rates? What sports pose the greatest risk to athletes?

Looking at the research on concussion rates

There have been several large-scale epidemiological studies, which have examined the incidence rate of concussions in various sports for male and female athletes. Many of these studies look at the concussion rates in practices compared to games as well as youth sports compared to adult sports.  We went through some of the research using recent systematic reviews and meta-analyses – which are basically a collection of ALL the research put together – to bring you a summary of the sports with the highest risk for concussion.

The results may surprise you…

Athletic exposures: how we measure concussion rates

The rate of concussion is generally measured in ‘Athlete Exposures’ (AE). This is defined as one athlete participating in one game or practice.

The numbers for concussion incidence rate are typically shown as “X” per 1,000 AE.

This means that there are “X” number – or a certain number – of injuries for every 1,000 times one athlete plays in one practice or game.

Let’s look at a sport like football. A football team has about 50 players on the roster. Therefore, a practice would equal 50 AE, and a game played between 2 teams would be 100 AE. In other words, 10 games is equal to 1,000 AE in American football.

Adult athletes (18 years and older)

According to a recent systematic review, examining the concussion rate in team sports, men’s rugby was found to have the highest incidence of concussion in both match play (3.00/1,000 AE) and practice (0.37/1,000 AE).[1]

Men’s tackle football came in second for match play concussion rate at 2.5 per 1,000 AE, and third for concussions experienced during practice (0.30/1,000 AE).[1]

Women’s ice hockey came in third for match-play concussions with 2.27 per 1,000 AE and second for practice concussions with 0.31 per 1,000 AE.[1]

Check out the full list below:

Game Play

  1. Men’s rugby match play (3.00/1,000 AE)
  2. Men’s American football (2.5/1,000 AE)
  3. Women’s ice hockey (2.27/1,000 AE)
  4. Men’s Ice hockey (1.63/1,000 AE)
  5. Women’s soccer (1.48/1,000 AE)
  6. Men’s football (or soccer) (1.07/1,000 AE)

During practice

  1. Men’s rugby (0.37/1,000 AE)
  2. Women’s ice hockey (0.31/1,000 AE)
  3. Men’s American football (0.30/1,000 AE)
  4. Women’s football (or soccer) (0.13/1,000 AE)
  5. Men’s ice hockey (0.12/1,000 AE)
  6. Men’s football (or soccer) (0.08/1,000 AE)

One important finding is that in sports played by both men and women, women sports typically had a higher rate of concussion. This is especially interesting in sports like hockey. Women’s hockey is non-contact, but has a higher rate of concussion compared to men’s hockey – which is full body contact.


Youth athletes (18 years and under)

Concussions in youth sports are particularly concerning as recent evidence suggests that the earlier in life a concussion is experienced, the higher likelihood of having prolonged complications. This is potentially due to injuring a brain that is still developing.

Similar to adult sports, the youth sport with the highest rate of concussion is rugby at 4.18 concussions per 1,000 AE.[2] Unlike the above study, the youth study did not separate injury rate by male or female, or by games or practice.

Ice hockey had the second highest concussion rate with 1.20 concussions per 1, 000 AE. American football came in third (0.53 concussions/1000 AE).[2] See the full list below:

  1. Rugby (4.18/1,000 AE)
  2. Ice hockey (1.20/1,000 AE)
  3. American football (0.53/1,000 AE)
  4. Lacrosse (0.24/1,000 AE)
  5. Football (or soccer) (0.23/1,000 AE)
  6. Wrestling (0.17/1,000 AE)
  7. Basketball (0.13/1,000 AE)
  8. Softball & Field Hockey (Tie) (0.10/1,000 AE)
  9. Baseball (0.06/1,000 AE)
  10. Cheerleading (0.07/1,000 AE)
  11. Volleyball (0.03/1,000 AE)

Concussion vs. other injuries

Concussions account for a significant number of injuries in high school sports. In a 2012 study, researchers found that concussions account for over 15% of all injuries in some very popular sports.[3]

  • Boys’ ice hockey: 23%
  • Girls’ lacrosse: 21%
  • Cheerleading: 20%
  • Boys’ lacrosse: 17%
  • Football: 17%
  • Girls’ soccer: 15%

There are some significant limitations to these studies. It’s important to realize that as many as 50% of all concussions are not reported. This could be for a variety of reasons such as the culture of toughness in sport or for fear of missing games, for example.

There are also many sports that are missing from these lists because they do not have reliable tracking metrics at this time. Please take the above information with a grain of salt.

Involved in sport? Concussions are bound to happen in sport, but how we manage these injuries can make a big difference. As part of our commitment to athletes and sport, we develop, implement and enhance evidence-informed concussion management programs for sports and schools. What are you doing to help keep your athletes safe? Provide the program that’s right for you and your athletes!



[1] Prien A, Grafe A, Rössler R, Junge A, Verhagen E. Epidemiology of Head Injuries Focusing on Concussions in Team Contact Sports: A Systematic Review. Sports Medicine. 2018;48(4):953–69.

[2] Pfister T, Pfister K, Hagel B, Ghali WA, Ronksley PE. The incidence of concussion in youth sports: a systematic review and meta-analysis. British Journal of Sports Medicine. 2016;50(5):292–7.

[3] Marar M, McIlvain NM, Fields SK, Comstock RD. Epidemiology of Concussions Among United States High School Athletes in 20 Sports. The American Journal of Sports Medicine. 2012;40(4):747–55.



This article is not intended as a substitute for the medical advice of doctors and/or healthcare professionals. The reader should consult their physician and/or healthcare providers in matters relating to their health, and in particular, with respect to any concussion and/or symptoms that may require diagnosis or medical attention.

This article was adopted from the Completely Concussion Management Resource Portal.  Click here for more resources.

What to do immediately after a concussion

Acute concussion care

Concussion is most commonly spoken about as a sports related injury.  We commonly see concussion in such sports as, hockey, football, cheerleading, soccer and horseback riding.  The reality is that these injuries can happen at any time, and not just during sports.

A concussion can occur slipping on an icy surface, falling in the playground or at work, hitting your head off of a low ceiling, or as a result of a car accident.

concussion treatment cycling

Regardless of the situation that led to the concussion, you should be aware of what steps to take immediately after sustaining a concussion.

Following a concussion, the first 24 to 48 hours are very important. Why? Because in some cases, there is potential for a more serious injury that may require immediate medical attention. This could include a brain bleed or swelling in the brain.

While it’s believed to be safe to take a nap or sleep after a concussion, the concussed person should be closely watched by an adult for at least 3 hours following the injury. The goal is to monitor for any signs of worsening condition. This could mean a more serious injury to the brain.

According to several studies, the rate of an abnormal CT scan in the emergency department following a concussion – which are potentially dangerous or life threatening – is up to 7% or less than 1 in 10 cases [1,2,3]. Of those cases, fewer than 2% require surgery [1,4]. In summary, the rates of these more severe complications are low, but they can happen.

Concussion Red Flags

Please take any and all precautions when a concussed person experiences certain symptoms after the injury. These Red Flags are signs of potentially more serious or life-threatening conditions.

Get medical attention at the nearest emergency department if you experience any of the following:

  • Bad headache that gets worse
  • Very drowsy or tired, or can’t be woken up
  • Vomiting
  • Can’t remember things that just happened
  • Can’t remember things 30 minutes before OR 30 minutes after injury
  • Can’t recognize people or places
  • Repeating the same things or questions over and over
  • Seizure
  • Blood coming from the ears, nose mouth or eyes
  • Bruising behind the ears, black eyes or very tender points on the face
  • Slurring words
  • Unsteadiness or severe balance problems
  • Weakness in the arms of legs


soccer concussion treatment management

The way that the injury happened may also play a factor.

For example, if you were in a car accident, hit by a car or fell down stairs, you should go to the emergency department as soon as possible. If you were using alcohol, cannabis or other illicit drugs at the time of injury you should also go to the emergency department to rule out more sinister complications.

A proper evaluation after the injury as well as evidence-informed advice about proper concussion management can have a big impact on your recovery.

The first 48 hours after concussion: What you can and can’t do

Rest: Do not go to sleep for at least 3 hours after the concussion. Make sure you have a responsible adult around to watch you for any signs of your condition getting worse.

If you’re the one watching the injured person, continue to talk to them. Are they slurring their words? Are they coherent? Do they know where they are? Are they repeating things? If you answer yes to any of these, take them to the emergency department.

Regular check-ins: This one is for the person monitoring the concussed person. Stand them up every 20 minutes, and have them close their eyes with their feet together. Are they wobbly? Are they swaying back and forth or side to side? If their balance is getting worse, take them to the emergency department.

Overnight check-ins: After 3 hours have passed, they can take a nap or go to sleep. While it’s not mandatory, we recommend that an adult checks on the injured person every 2 hours throughout the first night.

You don’t need to wake them up, but make sure they’re still breathing and seem okay. If there are any signs of their condition getting worse, take them to the emergency department right away.

Medication: Do not take any pain medication before talking to your doctor. Medications can “mask” the signs of a worsening condition and some can also increase the possibility of a brain bleed.

Make an appointment: You should get a full evaluation by an experienced healthcare practitioner that has specific training in concussion.  This appointment should be made within 2 days of the injury. Ideally, this would happen on the day of injury, or next day after injury. The faster you can get assessed by a healthcare provider with training or expertise in concussion management, the faster you can get on the path to recovery.

concussion physiotherapy

Follow the guidance of your healthcare provider, early treatment and rehabilitation can help you get back to doing the things you love.

Complete Concussion Management is a network of clinics and trained practitioners that provide evidence-informed concussion care for all those impacted by concussion.

Concussion treatment and baselines testing can easily be booked online via ODECA online booking system.

Looking for more resources on concussion and how to implement concussion policy in your sport? Visit Complete Concussion Management



[1] Easter, J. S., et al. (2015). Will Neuroimaging Reveal a Severe Intracranial Injury in This Adult with Minor Head Trauma? Jama, 314(24), 2672–10.

[2] Klassen, T.P., et al. (2000) Variation in utilization of computed tomography scanning for the investigation of minor head trauma in children: a Canadian experience. Academic Emergency Medicine, 7(7),739-44.

[3] Davis, R.L., et al. (1994) Cranial computed tomography scans in children after minimal head injury with loss of consciousness. Annals of Emergency Medicine, 24(4),640-5.

[4] Meehan, W. P., III, & Mannix, R. (2010). Pediatric Concussions in United States Emergency Departments in the Years 2002 to 2006. The Journal of Pediatrics, 157(6), 889–893.


This information is designed to provide education and awareness. This article is not intended as a substitute for the medical advice of doctors and/or healthcare professionals. The reader should always consult their physician and/or healthcare providers in matters relating to their health, and in particular, with respect to any concussion and/or symptoms that may require diagnosis or medical attention.