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Athletes Report Pressure to Keep Playing After a Head Injury

Researchers report it comes from parents, coaches, teammates, and fans.
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(Photo: Suzanne Tucker/Shutterstock)

(Photo: Suzanne Tucker/Shutterstock)

For all the recent revelations of the health risks posed by multiple concussions, plenty of athletes opt to stay on the field following a blow to the head. What prompts them to put themselves at risk for serious brain injury?

Newly published research suggests at least part of the answer is outside pressure from multiple sources.

A study of 328 male and female collegiate athletes found more than one-quarter of them “had experienced pressure from at least one source to continue playing after a head impact during the previous year.”

A research team led by Emily Kroshus, a post-doctoral research fellow with the NCAA Sport Science Institute, reports this pressure comes from four groups of people—coaches, teammates, parents, and fans—and is particularly hard to resist when it is voiced by all four.

The findings, published in in the journal Social Science and Medicine, suggest attempts to change athletes' behavior need to look beyond the coach-player relationship. Rather, authorities must take into account the “broader sports environment that includes pressure, both real and perceived, from others in the athlete’s environment.”

The athletes belonged to one of 19 participating teams from four "regionally competitive colleges.” They included six soccer teams, and three each for baseball, basketball, and lacrosse. Participants began by filling out a questionnaire designed to measure their knowledge about concussions, including their causes and consequences.

They went on to report their history of concussions, including whether they had continued playing in either a game or practice session after experiencing concussion-like symptoms; indicate the likelihood they would “report any symptoms I experience after a head impact if I think those symptoms are from a concussion”; and revealed whether they have felt pressure “to return to play after a head impact” from the any or all of the aforementioned sources.

“Consistent with recent estimates,” the researchers write, “around half of the athletes in the study indicated that they continued playing with symptoms of a possible concussion.”

Subtle—or perhaps not-so-subtle—coercion often played a role in that decision, and continues to factor into the players’ thinking. “More than one-quarter of the sample had experienced pressure from at least one source to continue playing after a head impact during the previous year,” the researchers report. “Athletes who experienced pressure from all four of the measured sources were significantly more likely to intend to continue playing in the future (following a suspected concussion) than were athletes who only (felt) pressure from coaches and teammates.”

Surprisingly, the researchers found no link between an athlete’s intention to report possible concussion symptoms and pressure from his or her coach. This suggests “it is likely that only a relatively small fraction of coaches ... are part of the problem.”

Rather, the pressure that really impacts their decision-making comes from “others in the sport environment,” including family members who are cheering them on from afar. A significant number of college athletes “perceive pressure from a parent or guardian to continue play after an impact,” the researchers write, adding that these players “are less likely to intend to report symptoms of a concussion.”

The results suggest a need for an educational program aimed at parents and other important figures in players’ lives, in which they explore “how they are communicating with injured athletes.” You may think you’re simply cheering your kid on, but too often, it seems, what’s coming across to him or her is the between-the-lines message “only wimps take themselves out of a game.”

If, as an athlete, you hear that from multiple sources, it tends to sink in, creating a keep-playing-no-matter-what mindset that is hard to defy. Encouraging speeches can have unintended consequences.