The Hit Was Friday. What Happens in Your Gym Monday?

The Hit Was Friday. What Happens in Your Gym Monday?

Football is in full swing. Somewhere in your building this week is an athlete who took a hit on Friday night and told everybody he was fine.

Dr. Komal Ashraf has heard that sentence more than anyone I know. When we recorded, she was a neurologist at the University of Missouri and the doctor behind the concussion program she started at Mizzou. She's been brought in more than once as the neurology expert on panels where people in professional football want her recommendations. She's also a competitive powerlifter, and these days she owns a gym of her own.

So she sees this from both sides of the door: the clinic and the weight room.

Here's what I want every coach and owner to take from our conversation.

It's not just football

Football gets the headlines. Dr. Ashraf sees concussions everywhere: "I see cheer. It's really huge. It's not just the flyers. It's actually the base." She told me about a track athlete who got concussed falling on a rainy track. It "really can happen in the pugilistic like the the the fighting sports or the collision sports and and really in any arena."

If your roster has cheerleaders, soccer players, wrestlers or baseball players, this is your post too.

If you've seen one concussion

Most of us picture a concussion as a kid who got knocked out. That's not the definition. A concussion is a mild to moderate brain injury with symptoms, and the symptoms don't line up neatly.

She asks about five areas: sleep, mental health, thinking (memory, focus, judgment, problem solving), pain in the head and neck, and movement, including eye movement, balance and hand-eye coordination.

Then she said the line I'd put on the wall of every coaches' office:

"If you've seen one concussion, you've seen one concussion."

Two players can hit forehead to forehead and walk away with completely different symptoms. One athlete can get a concussion from a cabinet door or a dog leash. There's no single look to watch for.

Why athletes hide it

I asked her whether concussion testing is the same across sports and levels. Her answer: "No, there's a lot of variability."

Some of the problem is the test. "What we do know is that the majority of people on the sidelines are getting just extra ocular motor testing, like look left, look right. Where are you? What's your name? We know that that's not adequate testing."

Most of the problem is the athlete. Symptoms are self-reported, and nobody who finally earned the starting spot wants to give it back. In her words: "there's an under-reporting problem, an advocacy problem. There's definitely a recognition problem."

That's where your coaches come in. You see these athletes three, four, five days a week. The doctor might see them once. If a kid's balance is off in warmups, if he forgets the cue you gave him twice, if his mood changes, your staff is often the first to notice.

Your job isn't to diagnose. It's to notice, to say something, and to get the family in front of someone qualified.

The 50% number

When athletes play through it, they think they're only risking their head. Dr. Ashraf gave me the number that changes that conversation:

"Playing with a concussion increases their risk of a musculoskeletal injury by 50%."

That means bone, tendon, ligament and soft tissue injuries. Achilles. Shoulder. A fracture.

And they won't perform like themselves either. "Maybe your first step won't be as fast. Maybe you won't jump as high. Maybe your judgment or executive functioning won't be as high." She told me about an athlete who went back on the field, the coach called a play, and he didn't know what it was.

Use that with the athlete who wants to tough it out. Hiding it isn't tough. It puts the season, the team and the next injury on the line.

Back to activity, with a plan

The old advice was to sit in a dark room until it went away. That's not the approach anymore. Dr. Ashraf's program is built on a simple sequence: recognize it early, intervene early, and build "a customized plan of care as early as possible to get people back to the level of activity that they're used to as quickly and safely as possible."

That plan comes from the clinicians, and it usually covers both the body and the brain. Her baseball players are a good example. They feel fine, "then they will get to the batting, they'll go to batting practice and they're like, my hand-eye coordination is totally off."

For an owner, that's the handoff that matters. When an athlete comes back to your gym, ask the family for the plan, follow it, and report back what you see. You're one part of a team that might include a physician, therapists and the school's athletic trainer. Be the part that communicates.

Nothing we do in a gym prevents every injury. What a good program can do is build a more durable athlete and catch problems sooner, so fewer of them turn into a lost season.

The parent conversation

The hardest part for a lot of coaches is talking to parents. Dr. Ashraf shared two conversations that I think every owner will recognize.

Early in one football season, a parent told her: "when we sign up for something, we stay, we are accountable, we follow through." Her answer: "yes, but he doesn't want to play." An athlete who doesn't want to be there won't learn the skills that protect him.

Another parent said his son was "fine for five seconds at a time." Her reply: "a lot can happen in these five seconds. That's how he got injured the first time."

She doesn't make the decision for them. She asks three questions: How much do you love it? How good are you at it? What's your future in it? Then she supports an informed decision.

I've always thought of this like an investment portfolio. A kid playing three collision sports is carrying a lot of risk. If he loves one of them most, take risk out of the rest of his life so he can keep the one he loves. Dr. Ashraf says the same thing in plainer words: "Live a safer life over here. Make better decisions. so that you can play the sport that you love."

Feedback that keeps the athlete talking

None of this works if athletes are afraid to tell you something's wrong. Dr. Ashraf is an educator as well as a doctor, and she believes "you can build somebody's ego up at the same time as giving them constructive criticism or feedback."

She also makes it two-way: "I have some feedback and then I asked for feedback as well." That's how you build a room where an athlete tells a coach he's dizzy before the coach has to figure it out.

Her favorite book for this is Crucial Conversations. It's a good pick for your staff meeting.

Now what?

Three questions for your staff this week:

1. Does every coach on your floor know the five areas to watch: sleep, mood, thinking, pain and movement?

2. When an athlete comes back from a head injury, who in your building gets the plan from the family, and who reports back?

3. Would an athlete in your gym feel safe telling a coach he isn't right?

If you want help building that into how your facility runs,book a Game Plan Sessionand bring your questions.

And if you want a snapshot of where one of your athletes stands across all six blocks — Mindset, Knowledge, Teammates, Training, Nutrition, Recovery — thefree Athlete Builder Assessmenttakes 8–12 minutes.

Lastly, I'm nominated for a podcast award and I need the public's vote. Please add your free vote here today: https://tophost.org/2026/jim-beebe Thank you!

This post is education, not medical advice. If an athlete may have a head injury, get them evaluated by a qualified medical professional.

Win the Day. Stay Relentless.

— Jim Beebe