With the recent nearly $800 million settlement, the NFL is conceding that head injuries occurred and led to serious long term problems. Despite this and all we hear in the media about the seriousness of concussion, the problem is still significantly under-reported. A recent study published this year showed that 4 out of 10 concussions suffered by high school athletes are never reported by the athlete.

When asked about the classic "bell ringer," less than one out of seven are ever reported. With the recent push to educate players, coaches and parents about concussion, the way we treat concussion has changed to protect the athlete from further injury. This doesn't help if the athlete is not reporting the injury to begin with.

It's difficult to convince the 'invincible' teenager that a head injury can have serious long-term consequences. Studies show the most common reasons for not reporting a concussion were that the player believed it wasn't serious enough, they didn't want to let their teammates down or they didn't want to be removed from play. What they don't realize is that the consequences may be devastating. Symptoms such as concentration problems, headaches and depression can be permanent. In my practice at Drexel Sports Medicine, players often present after multiple concussions and many will never resolve their symptoms.

One way to help the concussed athlete is to teach the players to recognize the signs and report when a teammate is hurt. Players wouldn't hesitate to report a player lying on the field with a broken leg. Consequences of a concussion can be much worse. Sadly, recent studies have shown that even with more concussion education, athletes were no more likely to report the injury. The fear of not being able to continue playing was the main deterrent.

Another way to help improve reporting is to help the athlete understand that by reporting their symptoms early they will get better faster and return to play sooner. Delaying treatment will delay recovery and potentially lead to more time being kept off the field.

The bottom line is that it's difficult enough to be an adolescent. Now we want them to admit, in front of their friends, that they are hurt and can't play. We as coaches, parents and officials must remain alert to the signs of a concussion, checking the athletes that were just involved in a big hit or after a tough game. Put the player first and don't push the envelope because he or she may be one of your best players. And players must be smart, honest, and when in doubt, sit the game out.

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