Between 2009 and 2014, all 50 states and the District of Columbia enacted legislation that required removing youth athletes from play following an actual or suspected concussion. Most of these traumatic brain injury (TBI) laws, commonly referred to as concussion laws, mandated that suspected athletes receive medical clearance before returning to play.

A new study from the Colorado School of Public Health at the University of Colorado has found that these state-level TBI laws have been beneficial in reducing the rate of new and recurrent concussion among U.S. high school athletes. Published in the November edition of the American Journal of Public Health, the study utilized data collected in a national injury surveillance system known as High School Reporting Injury Online (RIO).

“These concussion laws follow in a long-line of successful legislation efforts in public health injury prevention,” said Dawn Comstock, PhD, one of the study’s principal investigators and principal investigator of High School RIO. 

Ironically, the study noted that rates of concussion initially increase after a state law goes into effect. This is due primarily to better reporting attributed to greater awareness of the signs and symptoms of concussion. The authors indicate that the rates of recurrent concussions (a repeat concussion in an athlete that had already had at least one other concussion) declined significantly approximately 2 ½ years after a state’s TBI law was enacted.

“These laws make a difference. It is a great example of how legislative efforts can actually drive public health and injury prevention,” Comstock said.

Washington State, in 2009, was the first to enact a state law to protect young athletes from the consequences of suspected concussions. Known as the Zack Lystedt Law, it was named after a young athlete who suffered a head injury in a football game and returned to play prematurely, thus sustaining permanent brain injury.

“The Lystedt Law passed in Washington State was the first of many that raised the awareness of the importance of this injury as well as the importance of removing athletes from play when signs and symptoms of concussion are present,” said Dr. Margot Putukian, chair of the US Lacrosse Sports Science and Safety Committee.

The study looked at TBIs in high school athletes in nine sports between 2005 and 2016. During those 11 years, an estimated 2.7 million concussions were reported among players in the sports of boys’ football, boys’ wrestling, girls’ volleyball, boys’ and girls’ soccer, boys’ and girls’ basketball, boys’ baseball, and girls’ softball. Of the reported concussions, approximately 89 percent were new while 11 percent were recurrent. 

“The majority of concussions resolve in 10-14 days without any known long-term consequences. However, in a very small percentage, there are persistent symptoms and ongoing difficulties with cognitive function or balance,” Putukian said. “Younger athletes appear to take longer to recover and therefore should be treated with caution.”

High School RIO captures athletic exposures (number of athlete practices and number of athlete competitions per week), injury (body site, diagnosis, severity) and injury event (mechanism, activity, position/event, field/court location) data throughout the academic year using certified athletic trainers as data reporters.

Lacrosse was not among the sports tracked in this study, but boys’ and girls’ lacrosse are among the sports tracked annually via the RIO surveillance system. US Lacrosse contributes funding to RIO participants in order to help support the collection of lacrosse-related injury data. Further information about joining the RIO surveillance system is available online.

Additional information and resources about concussion awareness are available on the US Lacrosse website at  

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