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The Risk of Concussion Doesn't Discriminate...


But the opportunity to recognize one and intervene early isn’t always readily available to Black athletes.

A recent study published in the Journal of Head Trauma Rehabilitation (JHTR) found that among college athletes, concussion-related symptoms were recognized less by Black athletes than their White counterparts. Medically speaking, concussions don't discriminate. They can affect anyone (athlete or not) of any age (child or adult) at any time (a trip off a street curb is sometimes enough to cause one). Yet, studies like this one in the JHTR and others continue to reveal the real and urgent need to address the health disparities faced by Black people. This is especially true in terms of symptom recognition and access to specialized, and early intervention medical care. Recognizing the gap in concussion education for Black athletes is only a first step.

The JHTR study highlights that concussion is yet another area of significant disparity in healthcare, including essential, content-level information such as knowledge of concussion symptoms. The "playing field" is not level. Access to educational information is uneven. And the sources of educational information are inconsistent. A foundational principle of concussion management is early recognition and intervention. When symptoms are recognized, it is highly likely that disparities in treatment, outcome, and consequences for Black athletes also exist.

Of course, an essential next step in helping Black Athletes better recognize concussion symptoms is education. However, there is a difference between "education" and "meaningful knowledge transfer" (exchanging information in ways that change behavior). For instance, athletes may recognize the symptoms of concussion, but still under-report those symptoms when recognized (for several reasons.) Education provided in facts, figures, and fear means extraordinarily little if the desired change in behavior doesn't follow. So, we need not only level the playing field relative to concussion education, we also need to engage in meaningful knowledge transfer – connecting to athletes in culturally sensitive ways with messages they connect with, and a rational, optimistic/positive outcome to be expected when the desired behavior follows the educational information. Athletes need input from people they respect, using language and other forms of communication they relate to, and trust. When education and knowledge transfer utilize this approach, it is reinforced even more if the message is from a trusted messenger. Meaningful knowledge transfer should be the goal for all athletes, independent of race.

The issue of concussion education and treatment inequities has been demonstrated previously in youth and high school athletes – now in collegiate athletes. We must conduct continued research, and more attention needs to be paid to effectively educating Black athletes on the topic of concussion. The JHTR study brought to light some striking disparities in concussion symptom understanding, and I believe the results could have been even more alarming. The study participants included 768 collegiate athletes, 83 percent of whom were White, and 17 percent were Black. Sport types included contact, limited contact, and non-contact sports. I suspect if we were to determine the percentage of Black athletes playing the most popular contact sports (which include football and basketball), the rate would be much higher, and if we focused on those athletes who play the most – even higher. We're entertained each year by athletes in March Madness/Final Four basketball games and the Football Bowl Championship Series by large numbers and percentages of Black athletes participating while disadvantaged. Our athletes are further disadvantaged by disparities in income, housing, education, and other measures associated with a healthy life, liberty, and the pursuit of happiness. Improving and correcting the discrepancies in concussion education is the least we can do. It's critically important. But there are many additional areas and issues related to disparities that need to be addressed.

The truth is that Black people are severely disadvantaged. There are likely several contributing factors, including but not limited to socioeconomic status, insufficient school-based resources, lack of access to specialized healthcare providers (in the case of concussions, Certified Athletic Trainers and Sports Medicine team physicians), lack of access to credentialed coaching staff, lack of access to culturally competent medical providers, bias related to the interpretation of symptoms reported, differences in familiarity with medical/symptom-related terminology, and more. Though the JHTR study evaluated collegiate athletes, the issue doesn't start in college. These issues begin to separate us during youth sports, continue into high school and are further exacerbated in the college setting.

Suppose the problem with concussion symptom recognition begins before college. In that case, it is crucial to recognize the lack of access to Certified Athletic Trainers in youth and high school sports among disadvantaged athletes. This is a matter of safety. Even in the JHTR study, the most significant disparity in knowledge was among those athletes who had no access to an athletic trainer. A concussion comes to the attention of medical personnel and team physicians in 1 of 3 ways: Direct Observation, Symptom Report from the Injured Athlete, or Report of Recognized Signs/Symptoms from a 3rd party (teammate, parent, etc.). Early recognition of concussion is a cornerstone of treatment. Delayed treatment increases the risk of prolonged symptoms and delayed return to play. If symptoms aren't recognized as potentially related to concussion, there is an increased risk of additional injury (musculoskeletal and neurological), as well as prolonged recovery.

In Los Angeles, California, where I live and work, I serve on the board of an organization that supplies Certified Athletic Trainers to 5 inner-city high schools in the area. We provide concussion education, baseline screening, concussion management, in addition to pre-season physicals and orthopedic care throughout the season/school year to these schools. Our trainers teach a class in health education and sports medicine at each school. And we provide scholarships to some of the graduating seniors each year. Our trainers have saved lives. Our student-athletes are thriving in their sports (many earned scholarships and have gone to Division I college athletics and professional sports). They have also prospered as college students with some progressing to medical school. We are proud of our program's impact on their lives and the influence they will have on their families and in their community in the future. Programs such as these will help to further close the equity gap in concussion symptom recognition for all Black athletes, but in order for us to next the step, we must do much, much more. And we must do it together.