Sunday, November 6, 2016

Through an Athletic Trainer’s Eyes: More Than Just Getting Your “Bell Rung”

The topic of concussions has grown rapidly over the years and for very good reason. It is estimated by the CDC that between 1.6-3.8 concussions occur within sports and recreational activities annually.¹ A concussion, as defined by the UIL, is “a complex pathophysiological process affecting the brain caused by a traumatic physical force or impact to the head or body.” This may include, temporary or prolonged altered brain function resulting in physical, cognitive, or emotional symptoms, altered sleep patterns, and loss of consciousness. ³ The bottom line is concussions are something to be taken seriously because they are more than “just getting your bell rung.”
Unfortunately, when working with contact sports concussions aren’t something that can be avoided. Instead, we as athletic trainers must be proactive and aware of concussions and how they should be managed. The signs and symptoms of a concussion should be known by not only the athletic trainers but also the coaches and parents. Symptoms can become present at the time of injury or may occur minutes or hours afterwards.
Signs and Symptoms include:
  • Loss of consciousness
  • Balance problems
  • Difficulty with memory/concentration
  • Headache
  • Ringing in the ears
  • Nausea/vomiting
  • Confusion
  • Mood, behavioral, or personality changes
  • Blurred or double vision
  • Sensitivity to light/noise
  • Fatigue/drowsiness
It should be noted that the majority of concussions do not involve the loss of consciousness. In fact, loss of consciousness only happens is about 10% of concussions.² It is important that the athlete is honest about the symptoms they are experiences. This is where education of the symptoms of a concussion is important to all who have a relationship with the athlete.
download.pngAthletes at the high school or younger age, which present signs of a concussion, must be consulted by a physician.  As stated in the Texas Education Code, Section 38.157 the treating physician must provide a written statement indication that the student, by the physician’s judgement, is about to return to play.³ Once a written consent from the physician is given, the athletic trainer may begin the athlete on the return to play protocol.
Concussion should be taken seriously. Therefore the terms “bell-ringer” and “ding” should not be used, as these terms give a connotation that diminish the seriousness of the injury.¹ Recognizing the signs and symptoms is only the first step in the management of a concussion but a very crucial step.


¹Guskiewicz, K. M., Bruce, S. L., Cantu, R. C., Ferrara, M. S., Kelly, J. P., McCrea, M., . . . Valovich McLeod, T. C. (2004). National Athletic Trainers’ Association Position Statement ... Retrieved October 20, 2016, from
²Harmon, K. G., MD, Drezner, J., MD, Gammons, M., MD, Guskiewicz, K., ATC, Halstead, M., MD, Herring, S., MD, . . . Roberts, W., MD. (2013, January). American Medical Society for Sports Medicine Position ... Retrieved October 20, 2016, from 32 - CJSM Concussion Update - Sports Medicine&et_cid=190521&

³N., & S. (2014, November 21). Suggested Guidelines for Management of Concussion in Sports. Retrieved October 20, 2016, from


  1. I enjoyed reading this blog regarding concussion. I agree with most of the information; however, I do know from experience that although concussions are not 100% avoidable, as an Athletic Trainer, we use various precautionary methods to try to avoid them. Good read over all.

  2. Good Info! I know trainers and coaches do everything they can to take proper precaution when it comes to concussions, but I wonder, in a sport like football, thats fast paced with collisions everywhere, how many concussions go unnoticed. I know for me personally I can remember 3 or 4 times when I played that I got hit pretty hard, and as a player I thought wow that was a hit, but I never once thought to tell a coach or trainer to check me out.

  3. I enjoyed reading your blog on concussion. I agree with the information you shared and I think signs of concussion are more noticeable now than before.