Sports-Related Concussion

Researchers in the Center for Injury Research and Policy work on multi-disciplinary teams to investigate several factors related to sports-related concussion including concussion legislation, recovery from concussion, and concussion education and awareness. Sports are invaluable to children’s development. We encourage youth to participate in sports. We encourage policymakers and sports officials to follow and enforce rules and policies set in place to keep our athletes safer.

The tabs below provide a glimpse into Dr. Ginger Yang’s sports-related concussion research.

Dr. Ginger Yang completed a Robert Wood Johnson Foundation funded project in which her team evaluated the impact of state traumatic brain injury (TBI) laws on the rate of new and recurrent concussions among a nationally representative sample of high school athletes, and analyzed policy implementation at the school level. This project found:

  • Significantly increased trends in new and recurrent concussion reporting rates. These increases were observed from pre-law, through immediate-post-law, and into the post-law period.
  • Approximately two and a half years after the laws went into effect, the recurrent concussion rate showed a significant decline.
  • All participating high schools developed concussion policies to guide the implementation of their respective state's youth TBI law.
  • The language used in school concussion policies varied largely regarding policy enforcement (strictness of language indicated in the policy), policy description (details provided on the definition of the policy requirements), and policy implementation specifications (specific steps for implementing the policy requirements).

Dr. Yang and her team recently completed an RWJF-funded study that examined barriers to the implementation of state youth concussion laws within US high schools as perceived by high school athletic trainers. This study found:

  • Barriers to the implementation of the concussion education tenet occurred at the school level and included (1) lack of quality education, (2) lack of buy-in to educational requirements, and (3) lack of time for and attendance at educational meetings.
  • Barriers to the implementation of the removal from play tenet were from intra- and inter-personal levels and included (1) athletes underreporting concussion symptoms, (2) lack of communication, (3) resistance from parents and coaches, and (4) sport culture and “old school” mentality.
  • Barriers to the implementation of the return-to-play tenet centered on intra- and interpersonal barriers as well as policy-level influences and included (1) cost of and access to medical care, (2) resistance from stakeholders, and (3) lack of understanding of concussion.

The findings of this study provide insight into the barriers high schools encounter when implementing state youth concussion laws. Results can be used to inform the development of multilevel implementation strategies that aim to reduce these implementation barriers and promote high schools’ successful execution and application of state concussion laws, which, in turn, can help schools maximize the safety of their student-athletes. These findings also shed light on necessary updates and revisions to current state concussion laws.

Dr. Yang and her team are currently conducting a CDC-funded study examining the impact of Ohio’s Youth Traumatic Brain Injury (TBI) Law on changes in patterns of concussion-related healthcare utilization among youth aged 5 to 18 years old.

Concussion laws, the first law of their kind to address a specific injury and mandate medical attention, has led to increased concussion-related healthcare utilization. However, studies assessing the impact of youth TBI laws on healthcare utilization are limited, with very few studies examining the impact of primary care provider encounters despite over 80% of concussed youth initiating care with their primary care physician.

This study aims to assess:

  • The impact of Ohio’s youth TBI law on concussion-related medical encounters from pre- to post-law by sex, age, and injury mechanism; and
  • The impact of health insurance status and/or location of residence on concussion-related medical encounters from pre- to post-law.

Dr. Yang led a Centers for Disease Control & Prevention (CDC)-funded, 5-year, multi-site, prospective, multidisciplinary, collaborative research project that examined the influence of social support on injured Division I intercollegiate athletes’ physical and psychological outcomes. Main findings include:

  • Both male and female athletes who reported anxiety symptoms at preseason are at an increased risk of injuries during the prospective season as compared to their peers without these symptoms.
    • Only male athletes with co-occurring preseason depressive and anxiety symptoms are more likely to experience injuries compared with male athletes with no symptom co-occurrence.
    • The presence of preseason depressive symptoms with the absence of anxiety symptoms is not linked to an increased injury risk for male or female athletes.
  • While the orthopedic injury group showed greater fear of return-to play and fear of re-injury than the concussion group over time, the concussion group scored higher on depressive symptoms at 1-month post-injury than the orthopedic injury group, although both groups scored similarly at baseline and at 1-week post-injury.
  • Social support is an important coping resource for collegiate athletes dealing with psychological recovery from an injury.
    • More than 80% of injured collegiate athletes rely on social support from their athletic trainers during their recovery to help them cope with their injury.
    • Athletes who reported higher levels of satisfaction with the social support they receive from their athletic trainers during their recovery, the less likely they were to experience symptoms of depression and anxiety when returning to play.

Dr. Yang and her team, in collaboration with investigators from The Ohio State University (OSU) and University of Alabama Birmingham recently completed a pilot project, funded by OSU's Discovery Theme Initiative on Chronic Brain Injury. This study assessed driving performance after concussion in drivers aged 16 to 20 years using high-fidelity driving simulators. Specifically, the project:

  • Measured driving performance among drivers with mild Traumatic Brian Injury (mTBI) as compared to their sex-, age-, driving experience- matched healthy controls
  • Assessed the effect of increased cognitive load on driving performance among the drivers with an mTBI and healthy control drivers

Dr. Yang and her team are currently conducting a National Institute of Child Health and Human Development (NICHD)- funded study examining optimal levels of physical and cognitive rest after sports-related concussion among youth aged 11 to 17 years.

  • Current clinical guidelines for the management of sports-related concussion call for physical and cognitive rest following injury. However, these guidelines do not have a strong evidence-base.
  • The optimal levels of physical and cognitive rest needed to promote and facilitate recovery from concussion are unknown, precluding personalized rest plans for youth based on the characteristics of their concussion.
  • Findings from this study will be used to provide strong evidence for the development of personalized rest and treatment plans for youth post-concussion.

Dr. Yang and her team, in collaboration with Dr. Elaine Mardis from the Institute for Genomic Medicine and Dr. James MacDonald from Sports Medicine, are currently conducting a pilot project, funded by The Abigail Wexner Research Institute at Nationwide Children’s Hospital and The Ohio State University Discovery Theme Initiative on Chronic Brain Injury. The project aims to longitudinally monitor salivary expressions of a panel of microRNAs (miRNAs) over time in concussed children ages 5-17 years in order to identify biomarkers that can detect concussed children who are at risk for persistent post-concussion symptoms (PPCS).

Using biomarkers to identify risk of PPCS is especially critical for the development of individually-tailored treatment plans. This pilot study is significant and will inform the design of a larger, federally funded study. If the study hypotheses are confirmed, miRNAs could be used as biomarkers that can inform the design of clinical assays (e.g., spit test) for children with concussion, identifying children at risk of PPCS.


Dr. Yang and her team are currently conducting a pilot study funded by The Ohio State University College of Medicine Dean’s Discovery Grant Program & Nationwide/COM Cross-Campus Collaborative Pilot program that aims to develop a clinical decision support tool that can be used to improve treatment of pediatric concussion.

  • The expected product of this study is a prototype of a clinical decision support tool that can be used to monitor concussion symptoms, promote patient-centered care, facilitate shared decision making on optimal care, and improve clinical outcomes among pediatric concussion patients. 

Drs. Yang and McKenzie and their teams are currently working on a pilot study funded by a Connect and Collaborate grant that aims to develop an innovative, virtual reality (VR) mobile app to educate youth athletes about the signs and symptoms of concussion, the potential dangers of concussion, and the importance of concussion reporting. 

  • VR technology offers an innovative approach for concussion education by allowing youth athletes to “experience” concussion events and symptoms in a computer-generated environment that resembles the real world without experiencing an injury. 
  • This study will collect data that will inform the development of an educational tool that can be used to increase youth athletes’ concussion symptom awareness and recognition, and improve their understanding of the importance of reporting concussion. Youth athletes need this knowledge in order to recognize and report a concussion when one is suspected. 
  • Drs. Yang and McKenzie, in collaboration with a multidisciplinary research team, will develop an educational tool that aims to increase youth athletes' concussion symptom awareness and recognition before they experience an injury, and improve their understanding of the importance of reporting concussion. Youth athletes need this knowledge in order to recognize and report a concussion when one is suspected.

To help ensure the health and safety of young athletes, CDC developed the HEADS UP Concussion in Youth Sports initiative to offer information about concussions to coaches, parents, and athletes involved in youth sports. The HEADS UP initiative provides important information on preventing, recognizing, and responding to a concussion.

The Concussion Clinic at Nationwide Children's Hospital has a list of concussion signs and symptoms and has put together extensive guidance for a variety of audiences, below: 

Additional Sports-Related Concussion Resources

  • Concussion Recovery in Children and Adolescents: A Qualitative Study of Parents' Experiences
  • Association Between Design Elements of Concussion Laws and Reporting of Sports-Related Concussions Among US High School Athletes, 2009-2017
  • Are Concussion Laws Effective?
  • Barriers to the Implementation of State Concussion Laws Within High Schools
  • Concussion clinic presentation and symptom duration for pediatric sports-related concussions following Ohio concussion law
  • Differences in Postinjury Psychological Symptoms Between Collegiate Athletes with Concussions and Orthopedic Injuries
  • Consistency and Variation in School-Level Youth Sports Traumatic Brain Injury Policy Content
  • Common data elements collected among universities for sport-related concussion studies
  • Length of Recovery From Sports-Related Concussions in Pediatric Patients Treated at Concussion Clinics
  • New and Recurrent Concussions in High-School Athletes Before and After Traumatic Brain Injury Laws, 2005-2016
  • Physical examination of dizziness in athletes after a concussion: A descriptive study
  • Differential diagnosis of dizziness after a sports-related concussion based on descriptors and triggers: an observational study
  • Post-concussion symptoms of depression and anxiety in division I collegiate athletes
  • Social Support from the Athletic Trainer and Symptoms of Depression and Anxiety at Return to Play
  • Computerized neurocognitive testing for the management of sport-related concussions
  • High school concussions in the 2008-2009 academic year: mechanism, symptoms, and management
  • Hospitalisations for sport-related concussions in US children aged 5 to 18 years during 2000-2004
  •  The epidemiology of United States high school soccer injuries, 2005-2007
  • Blog Post

 For additional concussion resources from the Center for Injury Research and Policy, please click here.