If the word "concussion" was replaced by "brain injury" perhaps more athletes would admit that they've had one.
That was one suggestion from Scott Delaney, who led a study by a team from the McGill University Health Centre into athletes' attitudes toward concussions.
Their paper "Why Professional Football Players Chose Not to Reveal Their Concussion Symptoms during a Practice or Game" was published this month in the Clinical Journal of Sports Medicine.
Delaney's team hopes to find ways to get athletes to seek treatment when they experience concussion symptoms like headaches, nausea or blurred vision.
With multiple cases of Chronic Traumatic Encephalopathy, known as CTE, among former athletes suffering from the long-term effects of concussions making news in recent years, one might expect current athletes to be eager to seek medical help after a blow to the head.
But the McGill researchers found that while most know what a concussion is, how it may damage the brain and how they are treated, many either shrug it off or try to make sure no one finds out.
"Maybe we should just call it brain injury, which it what it is," said Delaney. "Maybe that would drive it home a little more.
"Concussions are so ubiquitous, maybe something as simple as changing the word we use can reinforce the severity of the injury. It might just change the culture if people said 'She injured her brain. This is serious. "' The research team surveyed 454 Canadian Football League players with support from the CFL and the CFL Players' Association. Players anonymously filled out questionnaires during the 2016 pre-season.
They found that 23.4 per cent felt they had suffered a concussion during the 2015 season and that 82.1 per cent of that group did not seek treatment for a suspected concussion at least once during the season. Only six per cent who said they would see a doctor after a game did so, and only about 20 per cent always reported concussions to the team medical staff.
The report's conclusions noted that "players seemed educated about the concussion evaluation process and possible treatment guidelines, but this knowledge did not necessarily translate into safe and appropriate behaviour at the time of injury."
"Presenting them with the facts is good, but not enough," said Delaney, head physician for the Montreal Impact of Major League Soccer, assistant physician for the CFL's Montreal Alouettes and team doctor for McGill's football team and men's and women's soccer squads.
"We have to somehow change the culture involved in concussions and make people better understand the risk and try to take the pressure off the players if they come forward."
About half of those who did not seek treatment said they didn't feel the injury was serious enough to leave the game. Other common reasons included fear of being taken off the field or of missing future games.
Delaney said peer pressure is another factor, as athletes don't want to let their team or their coach down, or they want to avoid being branded injury prone.
What does not appear to be a major factor is financial gain. He said CFL players' reluctance to admit to concussions was only slightly higher than what was found in a similar survey two years ago of unpaid student athletes on men's and women's teams in various sports at McGill and Concordia.
"They hid just as many concussions and they hid them for almost exactly the same reasons," said Delaney. "They didn't think it was very dangerous. They had done it before. They didn't want to miss this game or the next game.
"The issue of hiding concussions is not a professional football issue, it's a sport issue, and you can't make it better unless you understand why they're doing it."
He said diagnosing a concussion is near impossible unless the athlete comes forward and admits to having symptoms. The challenge is to find ways to encourage them.
He said that at McGill, athletes and coaches sign what he called a "concussion contract" stating that have read up on brain injuries and agree to report them.
"We want players and coaches, if they notice someone's not behaving well, to come and tell me," he said. "Sometimes you can't trust the player but maybe the community can help the diagnosis.
"They all understand they can be pulled out of a game, so they don't get upset at the time. We've agreed on this."
Like most sports leagues, the CFL and MLS have spotters who watch for players looking dazed or wobbly after a hit and can have them pulled aside for a quick concussion assessment. But they can't catch them all, and often symptoms don't appear right away.
Delaney would like to do a similar study on MLS players, which would present a language challenge because players come from many different countries. He was surprised that there are about as many concussions in soccer as in gridiron football.
Delaney's research team included kinesiologists Jeffrey Caron and Gordon Bloom and statistician Jose Correa.