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A professional soccer player bumped heads with another player while heading a ball in a game (Figure 240-1). She fell, sat up slowly, and then lay down on the field. She was noted to have a vacant stare and confused responses when evaluated on the field by a certified trainer. She was removed from the field, underwent a complete evaluation, and was diagnosed with a concussion. She complied with her cognitive and physical rest and her gradual return to activities. Her recovery was without incident, and she was released to return to play after 10 days.

FIGURE 240-1

Young women soccer players hit heads while heading a soccer ball. This is a common mechanism by which concussion occurs in soccer players. (Laszlo Szirtesi/licensed from Shutterstock.)


Sports-related concussions occur in athletes of all ages and skill levels engaged in many different sports (Figures 240-1 and 240-2). After a head impact, athletes are evaluated immediately and removed from play if there is any concern for a concussion. A full evaluation, performed shortly after, is needed to make the clinical diagnosis. The mainstay of therapy is cognitive and physical rest, with a gradual return to activities. Most adults recover within 10 days, whereas children may require up to 4 weeks for a normal recovery. Returning to play requires a release by a certified health practitioner.

FIGURE 240-2

Young football players take a knee while a coach and parent attend to a player who sustained a head impact while tackling another player. Both the coach and parent completed concussion education prior to the season. (Licensed from Shutterstock.)


  • Sports-related concussion (SRC) occurs in more than 10,000 U.S. college athletes each year, at a concussion rate of 4.47 per 10,000 athlete exposures.1 SRC is more common in competition (12.81 per 10,000) than in practice (2.57 per 10,000).1

  • Men's football, women's soccer, and women's basketball have the most reported SRCs among college sports; the highest concussive rates occur in men's wrestling (10.92 per 10,000), men's ice hockey (7.91 per 10,000), and women's ice hockey (7.5 per 10,000).1

  • SRC occurred at an incidence rate of 26.1 per 100,000 athlete-exposures in high school athletes playing football (men), or soccer, lacrosse, or hockey (men and women).2

  • High school athletes in the above sports have a 1.3% to 2.6% chance of concussion in a season.2

  • Nine percent of sports-related concussions are recurrent1; a concussion in the previous 24 months increases the risk of a second concussion by more than five times.2

  • Chronic traumatic encephalopathy has been described in athletes, particularly American football players and boxers, with repetitive concussive and sub-concussive head ...

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