Why Concussion Risks are Higher for Women

by Tony Doran, Psy.D.
HeadFirst Concussion Care Program Director
and Ann-Marie Sedor, HeadFirst Concussion Care Marketing

A number of research articles suggest that women are more susceptible to mild Traumatic Brain Injury. In fact, female college athletes have a higher rate of concussion compared to males when playing soccer (2.1 x greater risk), softball versus baseball (up to 3.2 x greater risk), and basketball (up to 1.7 x greater risk). So, why the difference? Research and anecdotal evidence has turned up three possible reasons: cultural differences; hormonal differences, or physiological differences.

female_concussion

Canada forward Christine Sinclair (right) and USA midfielder Carli Lloyd head the ball during the 2016 CONCACAF women’s Olympic soccer tournament at BBVA Compass Stadium in Huston, Texas, on February 21. Soccer is also among those sports programs that produce a large share of concussions for female athletes. — Reuters

Some experts have said part of the reason for increased concussions in females may be due to the reporting rate — that women are more likely than men to notify a coach they are injured, whether due to a head injury or other concern. Cultural differences indeed indicate a reluctance among males to report any injuries for fear of being removed from play. However, because of the very nature of concussion being a clinical diagnosis that usually depends on self reporting, it is hard to say that the incidence differences between the genders is due to honesty.

Other research suggests that hormones including estrogen, oxytocin, progesterone, and testosterone, affect recovery times from concussion. Of course, men and women have vastly differing levels of these hormones. One published study from the University of Rochester (NY) has also shown that menstrual cycles play a part in healing from head trauma. The research showed that women in child-bearing years experience greater cognitive decline, delayed reaction times, extended periods of depression, more headaches, and longer hospital stays and return-to-work plans compared to men following head injury.

Other articles suggest that longer and weaker necks of female athletes influence the potential for greater cervical injury and flexibility of the cervical ligaments. During a 2013 Youth Sports Safety Summit presentation, recent findings from athletic trainers showed neck strength and rigidity could help lower the chance of concussion. For every one pound increase in neck strength, odds of brain injury fell by 5 percent. Consequently, some the nation’s foremost authorities on concussion suggest female athletes participate in daily neck strengthening exercises.

Other research suggest that there are different neuronal connections between the hemispheres and significant lobes within the cerebral cortex for men and women potentially influencing recovery time. A recent Georgetown University Medical Center study showed that mice with a single head injury temporarily lose 10 to 15 percent of the neuronal connections in their brains, which can be repaired when at least a week of rest is provided. The fact that male and female brains are “wired” differently could account for a higher incidence of and/or a longer healing period after brain injury in women.

Realistically, interplay of all of these factors could potentially influence the differences in concussions between the number of concussions of female athletes and their recovery.

When Is the Right Age for a Child to Specialize in a Sport?

by Tony Doran, Psy.D.
HeadFirst Concussion Care Program Director

How many times have you seen parents running their kids from one sporting event to the next? Parents and kids feel the pressure to stay on the best team, with the best trainer, and the best coach to continue to progress in their sport.

At what age should a child or teen begin to specialize in a sport? Should kids go the route of gymnastics and figure skating and focus exclusively at an early age or should specialization be held off until high school or college when bodies and minds begin to fully form and develop?

An excellent article on the Steve Nash Basketball Blog addresses these questions and more.

Sports-Kids

Having been in the military, I had the benefit of having my children participate in school systems and sports programs up and down th
e Eastern seaboard. School systems and sports programs are not all the same. The culture within these communities created by principals, athletic directors, teachers, coaches, athletes and parents were a direct result of their collective focus and values.

As a psychologist, what I have found interesting is that the value system of sports and athletics tends to mirror one another. Within one community, children are not cut from a sports team – all children up to 9th grade may be able to try out and play on any team without getting cut. In the same community, children may not receive letter grades – or “competitive grades” – until the 8th grade.

Elsewhere, however, I’ve seen children cut from teams and competing for spots as early as 1st grade, when they also begin receiving competitive letter grades.

As with many things, the trick is in finding the right balance. Children in 1st grade cognitively can’t keep score and focus on the tasks of what they need to do on the field. What does a “D” in reading really mean to a first grader? A summary letter grade is an abstract concept that doesn’t teach very young children that they need to read more to improve their proficiency. The same applies to sports. An older child can understand the causes and consequences of a low letter grade, be it in academics or sports. But is waiting until 9th grade to be cut from a team too long to teach the lesson that life is competitive?

Another factor to consider are that traumatic brain injuries (concussions) will interrupt an athlete’s season and training. The type of community a child is living in and the focus of the coach, parents, athletic trainers, administrators, and other adults working, training and living with these young athletes can affect treatment outcomes in case of a concussion. Is your community one that is fostering hyper-competition that is focused on the top one percent or does it focus on age-appropriate health and well-being of all its children and how they all can benefit from athletic competition?

World Cup Again Brings Up Concussion Debate

by Tony Doran, Psy.D.
HeadFirst Concussion Care Program Director

It’s no secret in my family that I’m a die hard sports fanatic. I count the U.S. Women’s National Soccer Team’s win over China in 1999 as one of the greatest sporting events in our country’s sporting history – rivaled only by the win of the U.S. Hockey team over the Russians at the 1980 Olympics. Naturally, I was glued to the TV over the past few weeks while our U.S. Women’s National Soccer Team again clinched the World Cup championship last week.

Backtracking to the team’s semifinal game against Germany, analysis stated the U.S. did a great job on offense and defense, although the Germans came out hard with a flurry of shots and dominated the first 20 minutes of the action. Then, iIn the 28th minute, Germany’s Alexandra Popp went to head a ball on a free kick and USWNT’s Morgan Brian was having none of that and went up to meet her. The action happened so fast you could really tell what happened until FOX sports showed the replay. It turned out that Popp’s and Brian’s heads had violently collided.

Jun 30, 2015; Montreal, Quebec, CAN; United States midfielder Morgan Brian (14) and Germany forward Alexandra Popp (18) collide attempting a header during the first half of the semifinals of the FIFA 2015 Women's World Cup at Olympic Stadium. Brian and Popp were injured on the play. Mandatory Credit: Eric Bolte-USA TODAY Sports ORG XMIT: USATSI-230278 ORIG FILE ID:  20150630_ajw_bb5_045.jpg

Jun 30, 2015; Montreal, Quebec, CAN; United States midfielder Morgan Brian (14) and Germany forward Alexandra Popp (18) collide attempting a header during the first half of the semifinals of the FIFA 2015 Women’s World Cup at Olympic Stadium. Brian and Popp were injured on the play. Mandatory Credit: Eric Bolte-USA TODAY Sports ORG XMIT: USATSI-230278 ORIG FILE ID: 20150630_ajw_bb5_045.jpg

We all know the showmanship that sometimes appears in soccer when players grab a shin or a knee and throw themselves to the ground only to be up and running about at full speed moments later. But, when players are truly injured, their teammates are taught at a young age that whomever has the ball should kick it out of bounds so the hurt players can be attended to by medical personnel. The Popp-Brian collision was the first time I can ever remember the referee stopping the play prior to the ball actually going out of bounds.  After slamming heads, both Popp and Brian fell awkwardly to the turf.

Medical personnel from both teams game out and examined both players for 4 minutes and both teams played 10-on-10 for several minutes before both players returned to play the remainder of the game. Although neither player was knocked unconscious, the mechanism of injury was serious enough to have warranted a full 24 hours of observation before they should have been permitted to return to play.

Actions that FIFA can take to help teams and doctors make play safer for the players could include:
– have an impartial doctor on the sidelines, much like the referees who are from countries other than the teams playing, who can help assess injured players and protect the organization from future lawsuits; and
– add a substitute for teams in case a FIFA doctor rules that an injured player can’t return to the game to eliminate some of the pressure to keep playing.

Injuries like the Popp-Brain collision help drive home the point that kids younger than 14 shouldn’t be using their heads in recreational games until they are taught the right techniques and when their bodies have fully developed.

I’ve always said the benefits of sports far outweigh the risks, but that precautions need to be taken seriously. The risk of a head trauma is that athletes returning too quickly to play can suffer a second injury that could prove to be career-ending or, in the worst possibly case, fatal. Clinicians, parents, coaches and league administrators need to continue to evaluate the rules of sports collisions to ensure the safety of our children, the vast majority of whom will need their brains for something other than headers in the World Cup.

Run, Sam. Run!

This week over 2 million viewers watched Sam’s impressive speed and versatility on YouTube. Sam Gordon is a girl playing in an all-boys tackle football league in Utah.  Sam finished the 2012 season with a stat line that would make any parent and coach proud. According to the video, she scored 35 touchdowns on 232 carries, totaling 1,911 yards and averaging 8.2 yards per carry. And just for the fun of it, she also had 65 tackles.

It is hard not to watch this video and be wowed, but in this era of concerns about concussions, on all levels of football, this video raises some concerns.  The last minute of the video shows clips highlighting the 9 year old girl “taking a hit”.  Some of them are quite jarring. Gordon is not even 60 pounds, and there’s a kid on her team who weighs more than 150 – his nickname is Tank.

In his new book, Concussions and Our Kids: America’s Leading Expert On How To Keep Sports Safe And Protect Young Athletes, Dr. Robert Cantu – a clinical professor of neurosurgery at the Boston University School of Medicine — proposes that children should not play tackle football until they are 14 years old. The better game for children under 14 is flag football — in which kids grab flags rather than each other to stop the ball carrier.

Our message to Sam is simple: run, Sam. Run. Run so you can avoid the hits!

Meet Kelley

There are many brave people in the world but every once in a while you come across someone whose story is so inspiring that you are amazed by their ability to overcome adversity.

Meet Kelley, a courageous young lady who suffers from concussion. After being diagnosed, she made the decision to help educate others about the dangers of concussion and help other people realize they are not alone in their struggle. She has already spoken at schools on the topic of brain injuries, her story was featured in the summer newsletter of the Brain Injury Association of Massachusetts and, now, she has agreed to be a recurring contributor to our blog by posting journal entries about her ongoing saga.

This is Kelley’s Story:

“Ten months ago I sustained my second concussion while playing volleyball on my high school varsity team. Since then I have endured ten months of often excruciating headaches and neck pain. Ten months of home tutoring to help me keep up with my schoolwork because the lights and noises of the school environment are unbearable. Ten months of solitude to wrestle with the fact I may never be able to play the sport I love again. In all of those ten months confined to my home, I am yet to hear any encouraging words from my peers. It made the isolation worse and even harder to deal with. I wondered if other people had a similar story? Was there anyone else out there who is going through, or has gone through, this struggle with this kind of a traumatic brain injury? If I had someone else that was going through the same thing, I think it would be easier to deal with all of the changes in my life that I had no control over. I hope by contributing to this blog, I can encourage others. I hope people who are suffering through this injury know they are not alone, and that there are people who truly understand what they are going through. I also desire that people would read my stories and have a new compassion and understanding for those that they encounter who have been impacted by this silent brain injury.”

Concussion Crisis Growing in Girls’ Soccer

This evening at 9pm (EST), NBC Rock Center, hosted by Brian Williams, will report on the staggering numbers of concussions sustained by adolescent girls playing soccer. Female contact sports means concussions are no longer an issue just affecting boys. Read the full article here for more information about tonight’s program. Check out your local listings for the channel.

Courtesy NBC News