Primary prevention

Basic strategies such as wearing a helmet can help minimize the likelihood of major fractures and safeguard against subconcussive blows, but they do not prevent concussions.[38] Monitoring in-game fatigue in sports is a practical means of decreasing the chances for a concussive injury, but it cannot prevent an injury from happening.[39][40]

Measures that may be helpful in preventing sport-related concussion in children and adolescents include improving education and awareness of concussion, neck strengthening programs, and rule changes with proper enforcement of these rules.[3][37]​​​​

Studies of recreational activities such as snowboarding, skiing, all-terrain vehicle riding, and bicycling have also demonstrated a significant risk reduction in head trauma with helmet use.[41][42][43][44][45] Studies on helmet use in riders of bicycles, all-terrain vehicles, and motorcycles have consistently demonstrated a significant reduction in death and head injury.[45][46]​​

One meta-analysis demonstrated a protective effect of mouthguards against sport-related concussion in collision sports.[47] Some guidelines support their use in concussion management strategies in child and adolescent hockey but others state that mouthguards should primarily be used for preventing dental trauma, citing conflicting evidence regarding mouthguards and concussion reduction.[3][5]​​ Policies that disallow bodychecking in child and adolescent ice hockey are associated with a 58% lower concussion rate compared with bodychecking leagues; evidence supports no unintended injury consequences of policy disallowing bodychecking.[47]

Role of governance

To curtail the number of concussions, professional sports leagues (such as the National Football League) have adopted several rule changes targeting helmet-to-helmet contact, changing the strike zone to the shoulders and below, and immediate stoppages in play should a player lose his helmet. National Football League (NFL): rule book Opens in new window Although these rule changes and others like them may decrease the incidence of concussion, they do not prevent injury.[48]

Several governing bodies have implemented substantial rule changes to reduce incidence at the peewee and junior levels. In similar fashion, the National Hockey League has also introduced several rules with the aim of reducing concussive injuries.

Research environment

Current research efforts on prevention of concussion in contact and collision team sports are focused on:[49]

  • implementation and evaluation of rule changes

  • identifying risk factors for concussion (including genetic studies)

  • energy absorbing artificial turf and energy absorbing helmet technology

  • the role of tackling technique.

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