Keeping Players in the Game - Making Better Concussion Decisions
Why Athletes Are the Worst People to Ask About Concussion
Keeping Players in the Game - Making Better Concussion Decisions
Why Athletes Are the Worst People to Ask About Concussion
“How do you feel?” remains one of the most common questions asked after a player takes a hit to the head. The problem is that athletes often want to stay in the game. University of Utah researchers are studying better ways to recognize concussion while helping players, parents, coaches, and trainers make safer decisions.
Why Athletes Are the Worst People to Ask about Concussion
“She was not running in a straight line,” Grace Taeoalii recalled.
The first clue.
A fellow player had taken a soccer ball to the head. When teammates suggested she step off …. “No, I can keep playing!”
Grace wasn't convinced. “You need to sub this girl,” she told her coach. “She's running diagonal.”
The coach pulled the player off the field. She was later diagnosed with concussion.
It's the kind of moment that captures one of the biggest challenges in sports medicine. Sometimes everyone can see something is wrong … except the athlete.
Why Athletes Hide Concussion Symptoms
University of Utah neurologist Melissa Cortez works with athletes ranging from high school competitors to Olympians to pros.
One thing rarely changes. Athletes want to compete.
"Players are very good at no pain, no gain," she said. "But brain pain is not the kind that you push through. You're potentially causing worse injury."
The problem isn't that athletes are dishonest. The problem is that athletes are athletes.
Why Athletes Don't Report Concussion Symptoms
The Taeoalii sisters know exactly what Cortez is talking about. Faith, Grace, and Sariah Taeoalii have played soccer from youth leagues to international tournaments.
They've seen teammates hide symptoms, insist they're fine.
"Girls just want to play," Faith said.
At higher levels of competition, stepping off the field isn't a small decision.
"It's hard," Sariah said. "Once you're pulled out, you're done. You traveled so far, worked so hard. And you love the sport. You don’t want to disappoint your team or family."
That creates pressure. To stay in the game, to convince yourself you're okay, to answer "How do you feel?" with the answer everyone hopes to hear.
Can Athletes Game Concussion Baseline Tests?
Even when programs use concussion baseline testing, athletes sometimes find creative ways around it.
"I know girls who, when they took the baseline, purposely didn't do their best," Faith said.
Why? Because a lower baseline score makes it easier to pass later testing after a head injury. The logic may not be good, but it is human.
From the Sidelines
Why Concussions Are Different from Other Sports Injuries
Part of the problem is that concussions don't always look like people expect.
As Sariah stated, “Everyone knows the extreme symptoms, like forgetting stuff or blacking out or throwing up. No one knows the minor stuff.” Other concussion symptoms include:
- Headache
- Dizziness
- Difficulty concentrating
- Fatigue
- Balance problems
Even those symptoms are hard to interpret.
"If it's a headache," Sariah said, "it's hard to know if it's a concussion or if you just didn't eat enough or drink enough. Or it's the weather. Too hot. Or too much play time."
Taeoalii family matriarch, Kelly, sees another challenge.
"If your ankle is sprained or broken, you can't run on it," she said. "If you have a headache, you can still play."
Faith agrees. "It feels like concussions aren't as serious," she said. "It's not an ACL, right? It’s an injury that you can play through."
A concussion doesn't always stop an athlete from running. At least not immediately.
Concussion Education: The Most Underused Safety Tool in Sports
One of the most surprising things Cortez shared isn't about new research or gadgets. It's about tools that already exist.
Educational resources on concussion are easily accessible for everyone involved in soccer. There are CDC symptom checklists and videos. FIFA’s concussion toolkit has material for both pros and amateurs. All online.
Cortez takes this so seriously that she’s often boots on the ground herself.
“As part of our research mission, we've provided education. I do seminars with parents and coaches to teach them about the checklist. That’s a big piece of what I've been involved in over the years.”
Yet many people never receive meaningful training.
Kelly recalls that sports physicals were required for her kids. Concussion education wasn't. Parents typically receive a handout. That’s about it.
Faith remembers one season when a trainer spent several hours teaching athletes about concussion signs, symptoms, and baseline testing. It stood out because it was unusual. Most of the time, education was brief or absent altogether.
"You would be stunned how few trainers actually know all of the things on the CDC list," concurs Cortez.
And if coaches, parents, players, and trainers aren't speaking the same language, important symptoms can be missed.
Beyond "How Do You Feel?"
The Future of Sideline Concussion Diagnosis
Researchers like Cortez are working on another solution: objective data.
"We need objective measures of physiologic dysfunction that results from brain injury," she said. “We need to take the participant report out of the picture.”
Online Concussion Guides
Her research focuses on physiologic biomarkers that may help clinicians identify concussion and track recovery. Recent, similar research out of Australia uncovered a blood biomarker that could be key.
The goal is simple: Take some of the guesswork and pressure out of the decision. Right now, many sideline concussion decisions still come down to a player's answers.
How do you feel?
Do you have a headache?
Are you dizzy?
Those questions matter. But Cortez hopes future tools will help trainers and physicians make decisions based on what the body is showing, not just what the athlete is saying.
How Research Is Improving Concussion Safety in Soccer
The good news is that sports culture is changing.
Even FIFA has expanded concussion protocols for the 2026 World Cup, placing greater emphasis on player evaluation and safety.
Researchers worldwide, like Cortez, are helping push that change forward.
Not by telling athletes to stop playing, but by helping them recognize when it's time to step off the field.
Concussion Questions Parents Ask Most
Quick Concussion Q&A
What is a concussion?
- A concussion is a type of traumatic brain injury caused by a bump, blow, or jolt to the head or body that causes the brain to move inside the skull. Most concussions are mild, but they should always be taken seriously.
Do you have to black out to have a concussion?
- No. In fact, most people with a concussion never lose consciousness. Symptoms can be subtle and may include headache, dizziness, confusion, balance problems, fatigue, or difficulty concentrating.
If an athlete says they feel okay, are they okay?
- Not necessarily. Athletes are competitors, and many want to stay in the game. That's why coaches, parents, teammates, and athletic trainers all play an important role in recognizing concussion symptoms.
Why is a second hit such a big deal?
- A brain that hasn't fully recovered is more vulnerable to injury. Researchers have found that returning to play too soon can increase the risk of prolonged symptoms and a more difficult recovery.
Can athletes recover & return to sports after a concussion?
- Absolutely! Most athletes recover fully and return to play. The key is recognizing the injury early, getting evaluated, and following appropriate return-to-play guidance from medical professionals.
What's the difference between concussion & CTE?
- A concussion is a single brain injury. CTE (chronic traumatic encephalopathy) is a rare brain disease associated with repeated head impacts over many years. Having a concussion does not mean someone will develop CTE.
About this Series
Keeping Players in the Game is a three-part series exploring how neuroscience is helping make soccer safer—from preventing injuries, to improving concussion recognition, to helping athletes recover and return to play.
The series features research from University of Utah experts Melissa Cortez, DO, Carrie Esopenko, PhD, and Elisabeth Wilde, PhD.
The series also includes the perspectives of the Taeoalii family, Utah residents whose lifelong involvement in sports provided valuable real-world insight into athlete safety. Sisters Faith, Grace, and Sariah Taeoalii have played soccer from youth leagues through high school and college competition as well as in FIFA World Cup qualifier tournaments. Sideline expert and mom Kelly Taeoalii is her daughters' biggest fan and booster.
Special thanks to the Taeoalii family for sharing their experiences, observations, and years of insight from the field.
Reviewed by:
Melissa Cortez, DO, and KC Brennan, MD
Department of Neurology
University of Utah Health