Dangers of Repeat Concussion

  • Introduction
  • Ben Robinson
  • Josh Olsen
  • Prevention
  • Resources

Secondimpact syndrome (SIS) occurs when the brain swells rapidly, and catastrophically, after a person suffers a second concussion before symptoms from an earlier one have subsided. SIS occurs most often in sports, although any repeated blow can cause serious medical outcomes which need emergency treatment.

It takes minimal force from a repeated injury to cause irreversible brain damage because the brain is more vulnerable and susceptible. Damage from the initial impact damages the brain’s ability to self-regulate the amount of blood volume to the brain resulting in increased cerebral blood volume, which can result in brainstem herniation and death.

Brain death can occur in as little as three to five minutes.

In sports

When an athlete returns to play too early after suffering from an initial concussion, there does not need to be a robust second blow to the head to set the effects of SIS in motion. Even a minor blow to the head or a hit to the chest or back that snaps the head enough to have the brain rebound inside the skull can cause SIS.

Due to the quantity of media reports over recent years about CTE and suicide in professional sports, there has been an increase in research into the consequences of multiple head injuries.

Because of the media coverage, we have access to a lot of evidence-based information which helps us to be aware of the dangers, and thus improves the quality of our decisions and risk assessments.

What we need to understand is that concussions and head injuries don’t just happen to athletes – they can happen to anyone at any time, and there are multiple ways we can sustain a head injury – including whiplash.

Avoid any activity, be it sports or otherwise, where there may even be a minimum risk of a repeat injury.

Tragically, 14-year old schoolboy, Ben Robinson, died after playing rugby for his school on 29 January 2011.

Despite being treated three times for blows to the head, Ben was sent back into play each time. He collapsed and later died in hospital.

Ben’s mum and dad, Karen and Peter, continue to campaign for safety in sports.

A statement said, “At Benjamin’s inquest, the Coroner determined that Benjamin’s cause of death was Second Impact Syndrome due to head injuries he sustained during the rugby match. The Family’s legal team have gathered further evidence to confirm that Benjamin’s death was due to Second Impact Syndrome and was preventable.”

Scottish Sports Concussion Guidance:
grassroots sport and general public
2018 version. Adapted from the Berlin 5th International concussion consensus statement 2016.

In another story, Josh Olsen suffered multiple concussions, which resulted in ‘second impact syndrome.’ He spent almost a month in a coma and had to have multiple life-saving surgeries.

These stories are shared to help people to understand just how serious a ‘concussion’ can be.

There are multiple causes of concussion, and everyone needs to be aware of the dangers. We all need to be keenly aware of these, especially in respect of little ones and elderly seniors who will be less conscious or aware of dangers and activities to avoid.

Much of the focus on prevention on SIS is on young athletes because the rates of death and disability are higher in this populace. 

In light of recent and continuing research education regarding the proper diagnosis and management of a concussion needs to occur throughout sports communities at all levels. Everyone,  including the athletes, parents, coaches, athletic administrators, physicians, and sports medicine personnel, need to be aware of the dangers.

Sporting organisations, schools, colleges, and universities that do not heed the warnings and do not adequately treat concussions may end up paying the price along with the injured athlete.

The parents of Ben Robinson brought legal proceedings against, The Irish Rugby Football Union (IRFU), Ulster Rugby, World Rugby, Carrickfergus Grammar School, Neal Kennedy, the coach of the school team, and David Brown, the referee who officiated at the match. 

Preston Pleverete suffered a catastrophic second impact syndrome while playing football for La Salle University in November 2005. He had sustained an initial concussion one month earlier for which he had not received the proper treatment. Preston was then knocked unconscious when he collided head-on with an opposing player during a football game.

Although the surgeons were able to remove a massive blood clot from his brain, saving his life, Preston suffered irreparable damage to his brain and still struggles to walk and talk.

The Pleverete family received a settlement from La Salle University for $7.5 million. The jury found that the school failed to treat Preston’s first concussion properly, ultimately resulting in second-impact syndrome.

By treating concussion and taking players out of a game second impact syndrome is entirely preventable.

NCBI Sports-related concussion

Healthy Children.org Return to play

CDC Return to play


UKABIF Campaigns – Concussion and Sports related brain injury

Frontiers – Applying the Bradford Hill Criteria for Causation to Repetitive Head Impacts and Chronic Traumatic Encephalopathy