The Michigan High School Athletic Association (MHSAA) announced in January it was studying concussion trends among all sports to learn where, when, and how athletes are getting injured.

Television news outlet Mid-Michigan Now reported that concussions among athletes increased for the first time in four years of data collection. The MHSAA recorded 3,868 concussions among all schools in 2018-19, a slight increase over the prior school year.

An injured hockey player is attended to on the ice by the team doctor.

Even with the increase in numbers, Concussion Center Clinical Associate Director Dr. Andrea Almeida said this isn’t necessarily a bad thing.

“If the increase is due to greater awareness as suggested in the article, then with more education and awareness, there is improvement in injury recognition and management. By identifying an injury, the athlete is more than likely being removed from the activity, which is the first step in management,” she said. “This increase in number can demonstrate an increase in reporting as well, which may illustrate that athletes are taking this injury more seriously.”

Even with an increase in reporting, a 2017 study by researchers at Youngstown State and Michigan State Universities found concussions among high school athletes were under-reported by nearly 55 percent.

“There will always be those cases of under-reporters or the few cases where athletes may not realize at the time of injury that they suffered a concussion. With some concussions, symptoms do not begin right away; they can present minutes or hours later,” Dr. Almeida said.

Mid-Michigan Now surveyed more than 100 high school coaches about athletic trainers’ presence at sporting events and practices. 30 percent of coaches reported that an athletic trainer was not present at every game or competition and 70 percent reported that an athletic trainer was not present at practices.

“Athletic trainers serve as the first line of defense for these athletes, since they are often the first health care provider available to conduct concussion assessments and carry out post-injury management. They can provide recommendations on what to do and what to look for until the athlete sees a doctor. They can also help rule out situations where emergency care may be needed,” Dr. Almeida said.  A 2018 study published in the Journal of Athletic Training found that the presence of athletic trainers increased concussion identification and provided better treatment in the participating high schools.

According to the report however, school districts are not required to have athletic trainers on staff, and even if they were required, there wouldn’t be enough athletic trainers to fill each position. Additionally, it would cost the MHSAA, a non-profit, more than $39 million to fund an athletic trainer in each of the 749 schools it oversees.

With or without an athletic trainer present, state law mandates that if a concussion is suspected, the athlete is immediately removed from play. If no appropriately trained health care provider is available, the athlete is done for the day. In all cases, the athlete should be monitored for a deteriorating condition that would warrant transport to the emergency department. MHSAA guidelines require that an athlete cannot return to play the same day or following day without clearance from an MD or DO.

In cases where an athletic trainer is not available, educating athletes, parents, coaches, and school personnel remains key in preventing and managing concussions. As a result, the Concussion Center is offering two free online programs through the University of Michigan to help people learn about concussions.

The  Michigan Sport-Related Concussion Certification, developed in partnership with the MHSAA, this course provides coaches, parents, athletes, and athletic trainers basic information on concussions. Those who complete the training will receive a certificate of completion that satisfies State of Michigan sport concussion training requirements.

In the  Understanding Sport-Related Concussion Teach-Out, participants learn from concussion experts in the fields of neurology, engineering, law, journalism, athletic training, and concussion education policy and protocol. They will also hear from coaches, athletes, and parents who have experience working with sport-related concussions.