Study: Student-Athletes in Rural Schools May Be at Higher Risk for Repeated Concussions and Other Sports Injuries

SOURCE: National Athletic Trainers' Association (NATA)

Research Underscores Importance of Appropriate Care in Protecting High School Athletes

DALLAS – Student athletes who attended high schools with a low availability of athletic trainers (AT) – mostly in rural and inner-city areas – are 50 percent more likely to have a sports-related concussion (SRC) that goes un-identified, un-assessed or mismanaged, according to a study published in the National Athletic Trainers’ Association (NATA) Journal of Athletic Training.

More than 78 percent of the schools in the study with low AT availability are located in rural and inner-city areas. Athletes at schools with low AT availability:

  • Waited longer before the first AT interaction after an SRC (24 hours vs. 1 hour for mid and high AT availability schools);
  • Had fewer post-SRC interactions with an AT; and
  • Returned to play sooner than athletes at high and mid AT availability schools (2.5 days sooner).

“Providing student athletes with consistent access to athletic trainers is not a luxury, it is a necessity,” said NATA President Tory Lindley, MA, ATC. “NATA strongly recommends that parents advocate for their student athlete. Research continues to support the important role athletic trainers play in preventing and diagnosing injury. While the impact of sports far exceeds the risks, programs have an obligation to offer a safer approach – which includes appropriate care.”

Additionally, only 53 percent of “low AT availability” schools underwent a return to play protocol at all compared to 94 percent at “mid AT availability” schools and 100 percent at “high AT availability” schools. Returning to play too soon or without proper care increases the likelihood of a repeated concussion or other sports injury by up to 50 percent as well as increases the chance for catastrophic or long-lasting effects.

The research team gathered injury data on approximately 2,400 student athletes ages 14-18 in high schools across Wisconsin. Of the 400 schools that sponsor interscholastic teams in Wisconsin, only one-third have high AT availability, meaning an AT is available on a daily basis during school, practice and competition hours (equivalent to 35-40 hours a week). Another third of the schools have mid AT availability (during school and at varsity and sub-varsity events, or 10 to 15 hours per week). The rest have low AT availability (1 hour a week during the school day and at home varsity football games, or about 1 to 1-1/2 hours a week total) or no AT coverage at all. This is particularly problematic as 36 percent of SRC injuries occur during non-game situations.

The representative sample used for this study supports the most recent national survey conducted by the Korey Stringer Institute measuring AT services in public schools, which reported that 70 percent of secondary schools have access to an AT in some capacity, but only 37 percent have a full-time AT, which is the gold standard of care recommended by NATA.

NATA, the American Medical Association and youth sports advocacy groups have all recognized the value of having high school based ATs. However, implementation is inconsistent. The data underscores that it is important for parents to advocate for appropriate care on their child’s athletic teams.

NATA recommends three key questions to ask the school or athletic league to ensure your child is protected while playing sports:

1. Who is on the school’s sports medicine team and what is their level of availability?

Find out who will provide care to your child in case of an injury, and ask to review their credentials. NATA recommends that medical decisions be made by the school’s sports medicine professionals (physicians and AT) and not the coach. Coaches and athletes may knowingly and unknowingly make decisions that favor winning over safety.

2. Does the school or league have an emergency action plan?

Every team should have a venue-specific written emergency action plan (EAP), reviewed by the AT and local Emergency Medical Service. Individual assignments and emergency equipment and supplies need to be included in the plan. If an AT is not employed by the school or sports league, other qualified people need to be present to provide care. According to The Korey Stringer Institute, only 61 percent of states have met the NATA recommendation that every school or organization sponsoring athletics develop an EAP for managing serious or potentially life-threatening injuries.

3. Does the school have an automated external defibrillator (AED) and someone who knows how to use it?

Many schools today have AEDs on site during competitions, which if used efficiently and effectively can save a life by shocking the heart back into rhythm after cardiac arrest. Ensure that the medical expert and other personnel know where the AEDs are located, how to use them and that they are placed on sidelines during practices and games.

To learn more visit

About NATA: National Athletic Trainers’ Association (NATA) – Health Care for Life & Sport

Athletic trainers are health care professionals who specialize in the prevention, diagnosis, treatment and rehabilitation of injuries and sport-related illnesses. They prevent and treat chronic musculoskeletal injuries from sports, physical and occupational activity and provide immediate care for acute injuries. Athletic trainers offer a continuum of care that is unparalleled in health care. The National Athletic Trainers' Association represents and supports 45,000 members of the athletic training profession. For more information, visit At Your Own Risk is NATA’s public awareness campaign designed to educate, provide resources and equip the public to act and advocate for safety in work, life, and sport. In an effort to provide comprehensive information, the association has launched a website that provides recommendations on keeping student athletes and communities active and employees safe on the job. Visit

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