Doctors in Canada and the United States were raising alarms about concussions among athletes, which according to one study are reaching "epidemic proportions."

The Canadian study, entitled the Hockey Education Concussion Project, found that the debilitating injury could be occurring at a rate three times higher than previously thought and recommended an immediate cultural shift in how leagues, coaches and players handle concussions.

On the same day that study was released, a leading U.S. doctors' group issued a strongly worded call for coaches and managers to bench any athlete who they even suspect of having a concussion until they can be assessed by a qualified doctor.

All this attention could mean major changes to the way both amateur and professional sports treat the potentially devastating injury.

The hockey study followed 67 junior hockey players, aged 16 to 21, over the entire 2009-10 season and tracked the number and severity of their concussions, as well as how quickly they returned to play.

In the more than 50 games the doctors participating in the study observed, 21 players suffered concussions, five of them repeat concussions.

That was 3.3 times higher than in previous studies of concussions in hockey and led Dr. Paul Echlin to suggest that concussions are "occurring at epidemic proportions."

"Those are conservative numbers because of those not coming forward or those undiagnosed," he added.

The study calls for standardized treatment at ice-level for the injury, more education of players and coaches and better tracking of recurring concussion injuries.

Echlin, a sports medicine specialist associated with junior hockey, said the injury is happening at all levels of hockey, from children's leagues to the National Hockey League and can no longer be ignored or glossed over.

"Concussion is a serious brain injury that can cause short and long term disability among our athletes," he said. "We can no longer turn our collective heads when a concussion occurs, and hope for the best as has happened in the past."

He said that what is needed is a wholesale cultural shift in how hockey treats concussions, noting that some of the players in the study insisted on returning to the ice before they had completely shaken the effects of their concussion.

Echlin blamed that on "certain cultural factors such as athletes asserting their masculinity by playing through the discomfort of an injury, and the belief that winning is more important than the athlete's long-term health."

But Echlin says brain injuries stay with those affected and can even be permanent, pointing to previous studies showing that players return to the game after a concussion without realizing how seriously they were hurt.

It has been suggested that some legal muscle may be needed to help dampen the concussion epidemic at the lower levels. Coaches, parents and hockey associations could be made to take training on how to spot a concussion, CTV Toronto's John Musselman reported.

"If they don't have that training, their children can't play in that league," he said.

Echlin said there are 21 symptoms of concussions used by doctors. Some of the more common symptoms are:

  • Dizziness
  • Sensitivity to bright light
  • Lack of ability to remember things
  • Nausea

Echlin added that just one symptom could be enough for a concussion to be diagnosed.

The Canadian study's findings were echoed by the American Academy of Neurology, which on Monday set out a new position statement on brain injuries in sports.

The group, representing more than 220,000 doctors and researchers into the human brain and nervous system, issued a call for any athlete who had suffered a concussion – or even a suspected concussion – to be taken off the field and not allowed back until assessed by a qualified doctor.

Dr. Jeffrey Kutcher, chairman of the academy's sports neurology section, said athletes, coaches and administrators – even in high-impact sports such as football – often do not appreciate the potentially devastating effects of concussions.

"Catastrophic results can occur and we do not yet know the long-term effects of multiple concussions," said Kutcher, who helped drafted the academy's position statement. "We owe it to athletes to advocate for policy measures that promote high quality, safe care for those participating in contact sports."

Many neurologists have extensive experience caring for athletes who suffer concussions and the academy said that either a neurologist or specially trained doctor should be consulted before any athlete is cleared to return to play after a concussion.

"We need to make sure coaches, trainers, and even parents, are properly educated on this issue, and that the right steps have been taken before an athlete returns to the field," said Kutcher.

According to the Centers for Disease Control, sports-related concussions occur in the United States three million times per year, and among people ages 15 to 24 are now second only to motor vehicle accidents as a leading cause of traumatic brain injury.

Also Monday, the magazine Sport Illustrated released a special issue on concussions, discussing not only the frequent occurrence of the injury among National Football League players but also took a frightening look at the effects of sub-concussive hits on the head that are happening from minor-league football on up.

Researchers at Purdue University found that several high school players who took many light hits had measurable declines in their working memory and in visual memory, both skills that are keys to learning.