Concussion has recently dominated the news cycle. Whether referred to as a “head knock” by those downplaying the seriousness, or as “CTE” (Chronic Traumatic Encephalopathy) by attorneys engaged in potential lawsuits, brain injuries are a critical conversation in sports and beyond.
The Mayo Clinic provides this overview of concussion:
Overview
A concussion is a mild traumatic brain injury that affects brain function. While effects are usually short-term, they can include headaches, and issues with concentration, memory, balance, mood, and sleep. Concussions often result from impacts to the head or body that alter brain function. Not all hits to the head or body cause concussions, and only some cause loss of consciousness. Falls are the most common cause of concussions, but they’re also common in contact sports like American football or soccer. Most people recover fully after a concussion.
Understanding the difference between direct and indirect trauma is crucial. If the head sustains a direct blow, a resulting concussion is often obvious. There may be bleeding or a painful contusion, which signals the individual that something is wrong. More insidious are concussions resulting from indirect trauma; the brain moving within the skull may show few external signs, even if the injury is serious. An internal bleed may be “out of sight,” but certainly not “out of mind.”
The media has seized on the topic of concussion largely due to its prevalence in sports with massive audiences, including American football, rugby union, rugby league, and boxing. Military personnel also experience concussions at alarming rates — 1,600 per month in the USA — while countless others suffer injuries at home, in car accidents, and on school grounds. With five million Americans visiting clinics for concussion each year, it’s no wonder we view football as the primary cause. We watch football players as “weekend warriors,” inflicting trauma on each other in front of the public eye, while non-sports-related concussions remain relatively hidden.
Another factor is that, until recently, there were no set protocols for diagnosing concussion in sports. Rules draw attention to the problem, and vice versa.
As a primary health provider in rugby, I encountered one of the most challenging moments when requiring players to stand down after a concussion. Players would often argue, asking, “Where’s the rule that says I have to sit out?” To which I’d respond, “It’s my rule! I have to live with the consequences in 30 years—and with my conscience.”
From my 1980 book (well before the concussion rules that now govern rugby):
Diagnosis
Was the player unconscious? If so, they must leave the field, even if unconscious only briefly. (In boxing, an eight-second knockdown is enough for the referee to stop the fight.) The main sign of concussion is memory loss, so ask three questions:
What game is it? (A simple question)
What is the score? (A moderate question)
How were the points scored? (A more complex question, requiring 80-90% accuracy in high-scoring games)
Summary
Leave the field if advised by the captain or medical staff.
Avoid vigorous training for at least a week.
Take two weekends off from playing.
Consult a medical professional as soon as possible.
Refrain from drinking alcohol until cleared.
In ordinary life, we lack concussion rules outside of organised sports. Because sport has a structured framework, it also provides an avenue for lawsuits that everyday incidents do not. Legal action, however, may prove challenging. While the brain doesn’t fully recover from repeated concussions, many other factors—substance use, genetics, exercise, diet—can also affect brain health, complicating claims of causation. Even in the amateur era, athletes chose to play contact sports, often under little external pressure.
Though litigation isn’t the ideal solution for improving concussion management, it raises awareness. My chief concern is the lack of motivation and support for immediate first aid in youth sports and lower levels. The young brain is especially vulnerable, and early oversight could mitigate long-term injury.
There is progress. Sports administrators are addressing concussion as part of their duty of care, and New Zealand Rugby’s formal protocols now require stand-down periods for players post-concussion. The USA military, meanwhile, has collaborated with Abbot Industries to create a blood test that can confirm a concussion in 15 minutes. While not a panacea, rapid diagnosis by trained first-aiders remains the best approach to mitigate long-term harm—not only for concussions but for other injuries that might otherwise go unnoticed.
Measured against these challenges, the benefits of sports, when managed correctly, still outweigh the negatives. Trained, on-field support remains critical for immediate diagnosis and intervention, which will always be a more effective approach than litigation. As the legal world takes its stand, we may yet see first aid and preventative measures prevail.