Recognise the signs of brain injury in athletes

Brain injury is receiving increasing attention, particularly within the world of sport. Athletes, especially those involved in contact and team sports, face a higher risk of brain injury due to repeated impacts to the head. Recognising the warning signs is essential so that appropriate action can be taken as early as possible. This article explains the symptoms and possible consequences of brain injury and shows how athletes and coaches can identify the signs.

Recognising the Signs of Brain Injury in Athletes

Brain injury is receiving increasing attention in the world of sport. Athletes who participate in contact and team sports may be exposed to blows, falls and collisions that affect the head and brain. Recognising the warning signs is important because an athlete who continues playing after an injury may be exposed to further harm. Coaches, parents, teammates and athletes should therefore understand what brain injuries are, which symptoms may appear and what action should be taken.

What Is a Brain Injury?

A brain injury is damage or disruption to the brain caused by factors such as physical trauma, a lack of oxygen or infection. In sport, one of the most common forms is traumatic brain injury, also known as TBI. It can occur after a direct blow to the head or after an impact to the body that causes the head and brain to move rapidly.

A concussion is considered a form of mild traumatic brain injury. The word “mild” describes the initial medical classification and does not mean that the injury should be ignored. A concussion can temporarily affect memory, concentration, balance, emotions and reaction speed. An athlete does not need to lose consciousness to have a concussion. Symptoms may appear immediately, but they can also become noticeable several hours after the incident (Centers for Disease Control and Prevention [CDC], 2025a).

A brain contusion is a bruise to the brain tissue and is generally more serious than a concussion. It may involve bleeding or swelling and requires urgent medical assessment. Repeated head impacts are also a concern. Some impacts do not produce obvious symptoms, but researchers are studying whether repeated exposure may contribute to long-term neurological problems.

Chronic traumatic encephalopathy, commonly known as CTE, is a progressive brain disease associated with a history of repeated head impacts. It has been identified in some former athletes. However, CTE can currently only be confirmed through examination of brain tissue after death. Not every athlete who experiences concussions or repeated impacts will develop CTE. Research into the exact level of risk is still continuing (Patricios et al., 2023).

Common Warning Signs

The symptoms of a brain injury can be physical, cognitive or emotional. Physical symptoms may include headaches, dizziness, nausea, vomiting, vision problems and difficulty maintaining balance. An athlete may also become sensitive to light or noise or appear unusually tired.

Cognitive symptoms can include confusion, memory loss, slow responses and difficulty concentrating. The athlete may forget events that happened just before or after the impact. They may struggle to understand instructions, follow a conversation or remember the score. Some athletes describe feeling mentally slow, foggy or disconnected from their surroundings.

Changes in mood and behaviour can also be warning signs. An athlete may become unusually irritable, anxious, emotional or sad. Changes in sleep may occur as well. The athlete may sleep more or less than usual or have difficulty falling asleep. These changes are sometimes less visible than physical symptoms, which means that family members and teammates may notice them before the athlete does (CDC, 2025a).

Certain warning signs require immediate emergency care. These include repeated vomiting, seizures, slurred speech, increasing confusion, weakness or numbness, unusual behaviour, difficulty waking up and a headache that becomes more severe. One pupil may also appear larger than the other. These symptoms may indicate a more serious brain injury and should never be ignored (CDC, 2025a).

How to Respond

When an athlete shows possible concussion symptoms after a blow, fall or collision, the activity should be stopped immediately. The athlete should be removed from play and should not return to the same training session or match. A coach or parent should not try to decide how serious the injury is based only on how the athlete looks. The athlete should be assessed by a qualified healthcare professional (CDC, 2025b).

The athlete should be monitored because symptoms can change or become worse after the initial impact. They should not be left alone when serious symptoms are present. Emergency medical assistance should be requested when danger signs appear.

Athletes sometimes hide their symptoms because they do not want to miss an important match. Coaches should make it clear that reporting symptoms is a responsible action. Continuing to play while injured can affect balance, judgement and reaction time. It may also increase the chance of another collision.

Recovery should follow professional medical guidance. After a short period of relative rest, normal daily activities can often be introduced gradually as long as symptoms do not become significantly worse. Complete isolation in a dark room for several days is generally not recommended. The recovery plan should be adjusted to the athlete’s symptoms and personal circumstances (Patricios et al., 2023).

A return to sport must take place in stages and under the supervision of a healthcare professional. The CDC recommends a progression that begins with normal activities and continues through light exercise, moderate activity, heavy non-contact training, full practice and competition. Each stage normally takes at least 24 hours. If symptoms return, the athlete should stop and contact their healthcare provider before continuing (CDC, 2025c).

Prevention and Awareness

Brain injuries cannot always be prevented, but unnecessary risks can be reduced. Athletes should use correctly fitted protective equipment that meets the safety standards of their sport. Helmets and mouthguards can protect against certain injuries, but no piece of equipment can completely prevent a concussion.

Safe technique is also important. Rugby players should learn correct tackling positions. Football players should practise heading in a controlled way and avoid unnecessary repetition. Boxers and MMA athletes can reduce their total exposure by limiting hard sparring. Coaches should plan contact training carefully and use non-contact drills when full contact is not needed.

Education is one of the strongest preventive measures. Athletes, coaches and parents should receive regular information about symptoms and recovery. Coaches should encourage honest communication and pay attention to changes in movement, behaviour and performance. Medical checks can also help identify ongoing problems after an injury, although a routine examination cannot predict or prevent every concussion.

Consider a young football player who develops headaches and dizziness after several collisions during a match. The athlete may believe the symptoms will disappear and may not report them. A coach who recognises the change removes the player and arranges a medical assessment. The athlete is diagnosed with a concussion and follows a gradual recovery programme. In this situation, the coach’s awareness prevents the athlete from returning to play too early.

Conclusion

Brain injuries are a serious concern in sport. Physical symptoms such as headaches and dizziness are important, but memory problems, confusion and behavioural changes should also be recognised. When a brain injury is suspected, the athlete must be removed from play and assessed by a healthcare professional.

Coaches, parents and teammates all share responsibility for creating a safe sporting environment. Through education, honest communication, controlled training and a careful return to sport, the risks can be reduced. No match is more important than an athlete’s long-term health.

References

Centers for Disease Control and Prevention. (2025a, September 15). Signs and symptoms of concussion. https://www.cdc.gov/heads-up/signs-symptoms/index.html

Centers for Disease Control and Prevention. (2025b). Responding to a sports-related concussion. https://www.cdc.gov/heads-up/response/index.html

Centers for Disease Control and Prevention. (2025c, September 15). Returning to sports. https://www.cdc.gov/heads-up/guidelines/returning-to-sports.html

Patricios, J. S., Schneider, K. J., Dvorak, J., Ahmed, O. H., Blauwet, C., Cantu, R. C., Davis, G. A., Echemendia, R. J., Makdissi, M., McNamee, M., Broglio, S. P., Emery, C. A., Feddermann-Demont, N., Fuller, G. W., Giza, C. C., Guskiewicz, K. M., Hainline, B., Iverson, G. L., Kutcher, J. S., … Meeuwisse, W. (2023). Consensus statement on concussion in sport: The 6th International Conference on Concussion in Sport–Amsterdam, October 2022. British Journal of Sports Medicine, 57(11), 695–711. https://doi.org/10.1136/bjsports-2023-106898