This year’s Super Bowl is set between the Philadelphia Eagles and the Kansas City Chiefs looking for a historic three-peat. It marks the last game of the football season after the first-ever 12-team college football playoff. As football seasons become longer and other high-contact sports increase in popularity, mild traumatic brain injuries, or concussions, remain a common occurrence for many athletes.
It’s estimated that 3.8 million concussions occur in the United States each year from sport- and recreation-related injuries. In determining when it’s safe for athletes to return to the field following a concussion, much of the focus has been limited to assessing the physical side effects of these significant brain injuries — but what about the psychological side effects?
Reid Davis is a dual doctoral student in Clinical Science in the Department of Psychology and Department of Kinesiology at Michigan State University, where she studies psychological implications of returning to play following sport-related concussions alongside her advisors Professor Jason Moser and Professor Tracey Covassin. Prior to arriving at Michigan State, Davis worked at the University of North Carolina’s Matthew Gfeller Center, which was developed by current MSU President Kevin M. Guskiewicz, Ph.D.
Here, Davis shares three commonly believed misconceptions about concussions and the psychological readiness of athletes returning to sport.
Misconception No. 1: Everybody responds to concussions in the same way.
Concussions look very different across different people. There are six different types of concussions including cognitive, vestibular, ocular, anxiety/mood, cervical (neck) and migraine. (Here is a great podcast by two researchers including an MSU grad that provides an in-depth discussion on the different types of concussion.)
Some athletes may experience increased headaches while others may experience balance issues. Symptoms like these are physical signs that someone may not be ready to return to sport and can cue the sports medical team for how to get the athlete back to their optimal performance state. These physical symptoms can reflect their psychological state, as well, highlighting the interconnectedness of physical and psychological readiness for returning to sport.
Developmental factors and sex differences can also affect athletes’ responses to concussions. In a 2003 study, Covassin found that women are more likely than men in general to suffer from concussions in games. This may be due to a variety of different factors including hormones or even willingness to address their symptoms. Additionally, psychosocial factors, including women’s greater likelihood of reporting symptoms, may further explain this observed difference. Women may be more willing to acknowledge and address their symptoms compared to men, who might feel pressured to conform to traditional gender norms that emphasize toughness and playing through injury.
Misconception No. 2: Everyone is psychologically ready to return to sport when they are physically ready to return to sport.
Our understanding of the psychological side of sport-related injuries, specifically for sport-related concussions, is a growing field of literature. After an injury, athletes often are given a return-to-sport plan that addresses their physical healing. However, a 2024 study found that we are still in the process of developing similar frameworks for accessing psychological readiness. Effective assessment for psychological readiness requires expertise in both kinesiology and neuropsychology to accurately evaluate the complex issues athletes can face when dealing with injuries. Addressing this gap in knowledge and utilizing resources within these fields present an exciting opportunity to challenge misconceptions and enhance athlete well-being.
The lack of psychological readiness can manifest in various symptoms. One example is kinesiophobia, which is a fear of injury or reinjury. This fear can significantly impact individuals in their sport. If you think of a soccer player returning after a concussion, they may feel anxious about heading a soccer ball — a common action in one of the sports with the highest concussion rates. This anxiety can also sometimes evolve into anxiety in other areas of life rather than staying centered solely on movement-related fears.
Misconception No. 3: A universal protocol can decide when an athlete is psychologically ready to return to sport.
The psychological implications of injuries are quite comprehensive. When it comes to psychological readiness to return to sports, we need to view it more as a process rather than a strict protocol. This means that individualized treatment plans created by mental health professionals, athletic trainers and physicians are crucial, especially for creating a comprehensive plan for each individual athlete. The psychological implications of injuries are not one-size-fits-all.
When an injury occurs, there can be a tendency to overlook psychological aspects because of the belief that once the injury goes away, the psychological distress naturally resolves. But that’s not how the human brain works. This perspective does not account for the complexities of how the human brain processes injury and trauma. A 2006 study found that the brain has a remarkable ability to quickly develop patterns, including maladaptive coping mechanisms, fear responses and trauma-related behaviors. These patterns can become deeply ingrained, persisting long after the physical injury has healed and potentially interfering with an athlete’s ability to return to their previous level of performance or well-being. Therefore, it takes a village to help each athlete get back to their optimal state on their own timeline, both psychologically and physically. It’s an exciting time to study clinical psychophysiology because the wave of traumatic brain injuries research is growing, and I am looking forward to continuing my research at Michigan State.
