White Paper : Head Injury & Concussion In Sports

White Paper : Head Injury & Concussion In Sports

Author: Shelly Ann Brown


1.1 Early recognition


Sport involvement has become popular among children and teenagers. An estimated 30–45 million children and adolescents participate in non-scholastic sports and over 7 million adolescents participate in high school sports in the United States of America (USA) each year (Gioia et al., 2009; Karlin 2011). In the United Kingdom (UK) physical education and sport activities are considered vital for young children, being a compulsory national curriculum subject, mandated by the government. While their exists high participation rates from an early age, statistics reveal that sports-related injuries are common, accounting for almost 25% of all patients presenting to the emergency department (ED) with just a head injury (Kelly et al., 2001). The Centers for Disease Control and Prevention have reported that 20% of the estimated 1.7 million concussions that occur each year are sports related (Faul et al., 2010). National investments in protective gears and design, is of paramount importance in preventing brain injury early on and avoiding insurmountable healthcare expenditures in the future.


Concussion is a major concern for youth athletes who engage in contact and collision sports. A USA study found player-to-player contact, with 40% being sport concussion emergencies between 4–13-year-olds; while in the UK, Oxfordshire’s rugby union is the main sport in 0–19-year-olds responsible for more than 50% of all diagnosed concussions in males (Kirkwood, G., Hughes, T. C. and Pollock, A. M., 2019). These discoveries have sent ripples throughout the rugby community, with the majority of concern being within youth rugby; a higher percentage of head and neck injuries have been found in 15–19-year-old boys (21%) than in 10–14-year-old boys (17%) (Kirkwood, G., Hughes, T. C. and Pollock, A. M., 2019).


“it is now the most commonly recorded injury in professional rugby union in England and is increasing in incidence.”

(Kirkwood G, Parekh N, Ofori-asanso R, et al., 2015; 49:506-510)


While many see the benefits of sports and character building, it is now being weighed up by parents and guardians who want their children to grow but are doubting the safety side of these activities. Correcting this problem for the next generation of rugby players is essential and engaging early recognition can help in reducing head injury risks.



While research regarding concussion in sporting activities has progressed significantly over the years, only modest attention has been dedicated to adolescent concussion. Existing evidence suggests that children and adolescents take longer to recover than adults after a concussion (Grady, 2010). Additionally, young athletes are likely much more susceptible to concussions than adults, due to a larger head to body size ratio, weaker neck muscles and/or the increased vulnerability of the developing brain (Sim et al., 2008). Youth players are also at an increased risk of what is known as ‘second impact syndrome,’ a potentially fatal phenomenon where a player sustains a second head injury without fully recovering from the effects of the first” (Kirkwood et al., 2015).


There is a need for reliable data through routine monitoring and reporting in schools and clubs and in hospital emergency departments in order to inform prevention”

(Kirkwood G, Parekh N, Ofori-asanso R, et al. Br J Sports Med 2015; 49:506-510)


1.2 Post playing degenerative brain disease rugby and football dementia


Chronic traumatic encephalopathy (CTE) has been observed in athletes, military personnel and civilians that shares many features with known psychiatric disorders and other forms of dementia. Of lately, World Rugby, the Rugby Football Union and the Welsh Rugby Union has come under intense scrutiny from former players Steve Thompson, a World Cup winner with England in 2003, along with other former international players, for allegedly failing to protect players from the risks caused by concussions (BBC, 2020). Not alone is this transformation seen in the rugby field; in 2013 more than 4000 current and ex-NFL players in the USA, alleged that the NFL misrepresented the long-term health dangers associated with on-field head injuries. This resulted in a $765 million lawsuit settlement.


Former players and sporting authorities are now witnessing the devastating and lingering effects of participating in sports, without properly managing the safety of its players who regularly received blows to the head. This has left some with debilitating lifelong medical conditions such as dementia and chronic traumatic encephalopathy (CTE) (Bowen, 2020). For instance, a study developed by the University of Glasgow, discovered that rugby and football players are six times more likely to have a degenerative brain disease called “chronic traumatic encephalopathy” (CTE) which is caused by repeated blows to the head (Zanier et al., 2018).


Concussions and head injuries are therefore not new to the sporting arena, yet many of the specifics of concussions and head injuries pre impact is yet unknown. Questions like how much force is required to cause a concussion? Are there effective ways to prevent concussions? What are the effects of a head injury received during adolescence on long-term learning, memory, and behaviour? Are there ways to reduce or eliminate these effects? and Does a head injury received in childhood have long-term effects on motor skills as well as behaviour and learning? These remain unanswered and call for more research to be done.


1.3 Head Impact Trauma Limited (HIT)


While the literature on concussion in the adult competitive athlete has progressed dramatically, little attention has been focused on the young athlete and how this outcome varies across sports. Adolescent concussion is a common sports injury that has been sadly been underappreciated and mishandled. HIT provides research which aims to recognise Head Impacts by reading the force applied through the head area and flagging up large impacts. The aim of this system is to indicate the potential risk of injury before the player shows any signs of symptoms, removing the risk and grey area in recognising concussive injuries to the head.


HIT stands in the early stages of damage prevention, by providing advanced technologies that can recognise the impact of a concussion before one happens, monitoring head impact force throughout the wearable time of the safety device. Although very rare, repetitive head knocks can amount to a much more serious injury than concussion, known as second impact syndrome which can be fatal. Players in the national football league, NFL, claim that during a game they refer to a big hit as having your ‘bell rung’. The attitude to brain injuries is getting more serious but HIT aims to change the perception of head injuries and raise the awareness of the effects it can have if gone misdiagnosed or missed.


What makes HIT unique is the way the design represents itself to the audience. As much as collecting and transferring data in live time to coaches and players, HIT specifies as an indicator of head impacts, by visible emitting light when sensing a head impact force over the calibrated g-force. This has become a baseline level of care that will aid the knowledge and research for better understanding and recognising head injuries. The duty of care for such a threatening injury can be increased to prevent the sport from serious issues in the future and declining participation numbers, as the benefit of playing team sports such as rugby should be accessible without fear of injury (Bowen, 2021).


Providing advanced technologies that can aid reduced head impacts in young athletes will inspire more sporting activities with lesser fears from parents. At HIT, recognition prototypes are constantly being developed and incorporated into existing headguards for increased protection. As an entry level recognition prototype, this would be the least invasive way of introducing such a product to the game.




BBC (2020). Steve Thompson in group of ex-rugby union internationals to sue for brain damage https://www.bbc.co.uk/sport/rugby-union/55201237 (8 December 2020)



Bowen, (2020) Rugby’s Dementia Crisis, How this could affect the rugby landscape we know today. 



Bowen (2021). Origin of HIT 


Gioia GA, Schneider JC, Vaughan CG, et al. (2009). Which symptom assessments and approaches are uniquely appropriate for paediatric concussion? Br J Sports Med 2009;43(Suppl 1):i13–22. doi:10.1136/bjsm.2009.058255Abstract/


Karlin AM. (2011) Concussion in the pediatric and adolescent population: “different population, different concerns”. PM R 2011;3(Suppl 2):S369–79. doi:10.1016/j.pmrj.2011.07.015


Kelly KD, Lissel HL, Rowe BH, et al. (2001). Sport and recreation-related head injuries treated in the emergency department. Clin J Sport Med 2001;11:77–81. doi:10.1097/00042752-200104000-00003


Kirkwood, G., Hughes, T. C. and Pollock, A. M. (2019) ‘Results on sports-related injuries in children from NHS emergency care dataset Oxfordshire pilot: an ecological study’, Journal of the Royal Society of Medicine, 112(3), pp. 109–118. doi: 10.1177/0141076818808430.


Grady M. (2010). Concussion in the adolescent athlete. Curr Probl Pediatric Health Care 2010; 40:154–69. doi:10.1016/j.cppeds.2010.06.002


Sim A, Terryberry-Spohr L, Wilson K. (2008). Prolonged recovery of memory functioning after mild traumatic brain injury in adolescent athletes. Neurosurgery 2008;108:511–16.  doi:10.3171/JNS/2008/108/3/0511


Zanier, Elisa R., et al. (2018). Induction of a transmissible tau pathology by traumatic brain injury, Brain (2018). DOI: 10.1093/brain/awy193

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