A split image showing the dual nature of sports and brain injury — an athlete in motion and a caregiver reviewing medical information with a family member

Head Injuries in Sports: What Players, Parents & Families Need

Published by Robbins Nest Alliance | Brain Injury Education for Caregivers and Families

Every weekend, millions of parents stand on the sidelines cheering. Every day, athletes of all ages push their bodies — and their brains — to the limit. Sports build character, community, and resilience. They also carry real neurological risk that too many families discover only after something goes wrong.

This article is not here to tell you to quit sports. The science doesn't support that conclusion, and neither do we. What the science does support is this: informed families make better decisions. And better decisions save brains.

Here is what you actually need to know.

The Good: What Sports Do for the Brain

Let's start with what the research actually says about the brain benefits of physical activity — because they are real, significant, and worth naming.

Regular physical activity improves executive function, memory, and processing speed across all age groups. A 2023 narrative review published in Frontiers in Human Neuroscience found that physical activity induces meaningful changes in functional brain activation and can counteract psychological disorders and neurological decline at every stage of life (Ludyga et al., 2023).

Exercise increases levels of brain-derived neurotrophic factor (BDNF) — essentially a fertilizer for brain cells — and promotes neuroplasticity, the brain's ability to adapt, reorganize, and heal. This is not a small finding. It is one of the reasons that structured physical activity is now considered one of the most powerful non-pharmacological tools we have for brain health.

For veterans and others living with PTSD, TBI, and mood disorders, the data are particularly compelling. A 2025 editorial in Frontiers in Human Neuroscience highlighted research showing that movement-based interventions may have particular value for brain-injured populations (Majumdar, 2025).

Sports also provide something that cannot be measured in a lab: belonging, structure, identity, and purpose. These psychosocial benefits matter enormously for brain health, especially in adolescence and in recovery.

The bottom line on the good: Physical activity and sport, done safely, are genuinely protective of brain health. The goal is not to eliminate risk. The goal is to understand it.

The Bad: When Sports Hurt the Brain

A head injury is not the same as a brain injury — but in sports, they often are.

Before we go further, it helps to understand the distinction. We break this down fully in our article Concussion vs Brain Injury: What's the Difference?

A concussion is a mild traumatic brain injury (mTBI) caused by a bump, blow, or jolt to the head that disrupts normal brain function. You do not have to lose consciousness to sustain a concussion. You do not have to take a direct hit to the head — a hard hit to the body that causes the brain to move rapidly inside the skull can cause the same injury.

The numbers are significant. A 2024 report from the U.S. National Center for Injury Prevention and Control found that 63.6% of reported traumatic brain injuries in children resulted from participation in sports, with 41.1% attributable to contact sports specifically (Huber et al., 2025, eBioMedicine).

What to Watch For

Concussion symptoms can appear immediately or develop over hours. They include:

  • Headache or a feeling of pressure in the head
  • Confusion, feeling "foggy," or slowed thinking
  • Dizziness or balance problems
  • Nausea or vomiting
  • Blurred or double vision
  • Sensitivity to light or noise
  • Memory problems — including not remembering the injury itself
  • Mood changes, irritability, or emotional dysregulation
  • Sleep disturbances

Important: The absence of loss of consciousness does not mean no brain injury occurred. Many significant concussions involve no loss of consciousness at all.

For a deeper look at concussion symptoms in both adults and children, watch:

Families often notice subtle signs before anyone else does. Learn what those early warning signs look like in our article 6 Early Signs of Brain Injury Families Often Notice First — or watch:

When to Seek Emergency Care Immediately

Call 911 or go to an emergency room without delay if any of the following occur after a head injury:

  • Loss of consciousness, even briefly
  • Repeated vomiting
  • Seizures
  • One pupil larger than the other
  • Extreme drowsiness or inability to be awakened
  • Worsening headache
  • Slurred speech
  • Increasing confusion

These are signs of a potentially serious brain injury that requires immediate medical evaluation.

The Ugly: What Families Don't Know Until It's Too Late

Here is where we have to be direct with you.

The Prior Injury Problem

A brain that has been injured before is not the same brain it was before that injury. Research consistently shows that a history of concussion or TBI increases vulnerability to subsequent injury and can alter how the brain responds to stress, danger, and risk.

This shows up clinically in ways families often misinterpret. Impulsivity, risk-seeking behavior, poor decision-making, and emotional dysregulation following TBI are documented neurological sequelae — meaning they are consequences of the injury itself, not simply personality or choice.

When a young person who has sustained a prior brain injury continues to engage in risky behavior, that pattern deserves neurological evaluation. To understand why brain injuries change behavior and personality, watch:

Brain injuries also affect emotional regulation in ways that are often mistaken for anger or defiance. This matters enormously for families trying to understand what they're seeing:

For more on how repeated hits accumulate over time, read: Do Repeated Hits to the Head Cause Long-Term Brain Damage?

Second Impact Syndrome

One of the most serious and least-known risks in sports brain injury is Second Impact Syndrome (SIS).

SIS occurs when a person sustains a second head injury before fully recovering from the first. The result can be rapid, catastrophic brain swelling — diffuse cerebral edema — that is often fatal or permanently disabling. The brain exists in a state of heightened metabolic vulnerability for approximately 10 to 15 days following an initial concussion (Physiopedia, citing Bey & Ostick, 2009).

According to a review published in Pediatric Neurology, SIS occurs when a second concussion strikes before symptoms from the first have resolved, causing diffuse and potentially catastrophic cerebral edema (Weinstein et al., 2016). Though relatively rare, it is often deadly — which is why return-to-play protocols following concussion are not bureaucratic caution. They are life-safety measures.

A prior TBI is not a reason to panic. It is a reason to be informed and to have a neurologist on your team.

Cumulative Impact and Long-Term Risk

Not every athlete who sustains head injuries will develop chronic traumatic encephalopathy (CTE). That is true and important to say clearly. CTE is a post-mortem diagnosis — it cannot be confirmed in a living person. To understand why that matters and what it means for families, watch:

What the research does show is that repeated concussions carry cumulative risk. A 2022 retrospective cohort study published in the Journal of Neurology, Neurosurgery & Psychiatry examined 412 former Scottish rugby players and found elevated rates of neurodegenerative disease compared to matched controls (Huber et al., 2025, eBioMedicine).

For a deeper understanding of how this cumulative damage happens, read:

A Note for Veteran Families

CTE and TBI are not only sports injuries. Veterans who experienced blast exposure, repeated concussions during service, or physical trauma carry these same risks — often without ever having played a contact sport. Read more:

What To Do: A Family Action Plan

If a Head Injury Happens

  1. Remove from play immediately. No same-day return. This is not optional.
  2. Seek medical evaluation. A physician familiar with concussion management should evaluate the injury.
  3. Do not minimize symptoms. "They seem fine" is not a clinical assessment.
  4. Follow return-to-play protocols — graduated, stepwise return to activity only after full symptom resolution.
  5. If there is a history of prior TBI, tell every medical provider. This changes the clinical picture.
  6. Watch for red flag symptoms listed above. When in doubt, go to the emergency room.

If You Are a Caregiver for Someone With a Brain Injury History

Resources

Citations

  • Clifton, et al. (2025). The Incidence of Sports-Related Concussion in Children and Adolescents: A Systematic Review and Meta-Analysis. PMC11992322.
  • Huber, et al. (2025). Protecting brain health: neurocognitive risks in sports players. eBioMedicine. DOI: 10.1016/j.ebiom.2025.105812.
  • Ludyga, et al. (2023). Move Your Body, Boost Your Brain: The Positive Impact of Physical Activity on Cognition across All Age Groups. PMC10296541.
  • Majumdar, V. (2025). Editorial: Exercising body & brain: the effects of physical exercise on brain health. Frontiers in Human Neuroscience. PMC12748147.
  • Ntikas, et al. (2024). Contrasting Characteristics and Outcomes of Sports-Related and Non–Sports-Related Traumatic Brain Injury. JAMA Network Open. DOI: 10.1001/jamanetworkopen.2023.53318.
  • Weinstein, et al. (2016). The Controversial Second Impact Syndrome: A Review of the Literature. Pediatric Neurology. PMID: 27421756.
  • StatPearls. (2023). Second Impact Syndrome. NCBI Bookshelf. NBK448119.

Robbins Nest Alliance is a 501(c)(3) nonprofit providing peer-reviewed brain injury education for caregivers and families. We are not a medical provider. This content is for educational purposes only. Always consult a qualified medical professional for diagnosis and treatment.

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