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.

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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.

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White Sox’s Konerko Felt Helpless & Depressed After Concussion

Last month, Chicago White Sox first baseman Paul Konerko suffered a concussion after being struck in the right temple by Kansas City Royals outfielder Jarrod Dyson. After a gradual return to play, which included working out a little more than a week after the concussion, Konerko is now back on the team in full force.

What’s refreshing about Konerko, aside from the fact he took his concussion seriously enough to stay out of the game until he healed, is his honesty about the alarming effects of concussion.

In a video interview with Comcast Sportsnet, Konerko described feeling helpless, depressed, unmotivated and lethargic immediately after his brain injury.

“You just feel like a different human being. You just feel like out of the world. It’s just a weird feeling,” said Konerko, who took the ImPACT test after his injury to help diagnose the concussion. He described his emotional state not feeling like himself. “You almost feel, you don’t care about anything.” Konerko also said it hurt for several days just to shift his eyes.

In the video below (will open in a different page), Konerko provides an incredible glimpse into the physiological and psychological symptoms of brain injury.

The one part we take exception to is Konerko’s account [beginning at 1:16] of being blindsided by the actual impact which allowed for a “better chance of getting rattled and the brain moving.” The fact is we know that nothing, not even anticipating a blow, can prevent the brain from moving inside the skull.

Concussion TV Offers Online Videos and Webcasts

Concussion TVAs concussion awareness rises, so does the variety of educational resources available. Internet TV Channel, part of the Sports Pro Community Network (SPCN TV) is an online network committed to bringing athletes, parents, coaches, athletic trainers, personal trainers, medical and sports business professionals the latest information on concussions and traumatic brain injury (TBI). The website is filled with free videos and webcasts featuring renowned specialists and parents of youth athletes discussing this “silent injury.”

Retired NFL Player Kurt Warner Puts Family First

We came across this incredible editorial written by Kurt Warner for the June 12, 2012 issue of USA Today. It blasts through stereotypes on many levels, from the notion that football players are “dumb jocks” to the perception that the game is all-important. Warner has delivered a thought-provoking essay about the issue of concussions in youth sports in a style that is nothing less than poignantly eloquent.

Kurt Warner and son, Kade. (Courtesy Brenda Warner)

Like many Americans, I am passionate about the game of football. I love the strategy, the competitiveness, the discipline and the effort required to succeed as a team. I respect the values the game teaches. But I’m acutely aware of the one aspect of the game I don’t love — the violence. Kurt Warner and son Kade.

Recently, with the shock of Junior Seau’s suicide fresh on my mind, I shared my concerns about my own boys playing football because of the risks of concussions. Some people labeled me a traitor, and others said I was sabotaging the NFL. How dare I criticize a game that gave me so much?

As a parent, I expressed my unease precisely for that reason. I love the game deeply, and love my kids even more deeply. That’s why we need to do everything in our power to make the game as safe as possible.

I’ve spent 22 years helping raise a child who has a traumatic brain injury. I understand the perils that these conditions can cause firsthand. Our son Zack, who suffered an accident as a baby, is an awesome blessing, but it moves me to watch the daily struggles he endures. For that reason alone, I hope people can understand my fear of placing any of my kids in an environment where brain trauma is a possible byproduct of the competition. My sentiments about my boys playing football are reflective of that.

Sports and life lessons

To be clear, few things bring me greater joy than watching my boys play football. They are learning some incredible life lessons and absorbing the values the sport instills. But I know the violence intrinsic to the sport. That knowledge carries as much, if not greater, importance.

I spent 12 seasons as an NFL quarterback. I suffered concussions. I was trained to be tough and play through injury. No doctor could say for sure whether I suffered lingering effects. Those concussions led me to walk away from the game I love. As my boys continue to play, I worry about them every time they get hit, just as my wife worried about me every time I got hit.

More than worrying

It isn’t enough, though, for parents to worry. We all know that injuries are part of football. We fall short as guardians if we don’t try to reduce traumatic injuries such as concussions, especially with the information we now have. If we’re going to be supportive of our kids’ passion to play, then we need to educate them about the risks as well.

NFL commissioner Roger Goodell is doing all he can to improve safety. There are signs of improvement through better equipment or changing what is acceptable in terms of hard hits. NFL protocol mandates that any player showing concussion-like symptoms cannot re-enter a game.

Last year, my son Kade was required by his Pop Warner team to undergo a baseline test to analyze brain function in a normal state so that if he suffers a concussion, officials have a comparison. These and other safeguards are helping players, coaches, parents and doctors to treat concussions and avoid putting someone back into a situation where more damage can be done.

For me, the benefits almost always outweighed the risks. The game helped shape me into who I am today. When I think about my own boys, especially with Father’s Day coming up, it’s sometimes hard to feel that the thrills outweigh the dangers.

Consequently, I support all improvements in player safety in hopes that the game has a long and healthy run as the greatest team sport in the world. We owe it to the generations of players to come, and as parents, we owe it to our kids to educate and protect them.

Kurt Warner is a retired quarterback, a two-time NFL MVP and an NFL Network analyst.

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.”

An Open Letter to Justin Bieber

© Bill Davila / Startracks

Dear Justin:

By now, most of us know you sustained a concussion yesterday by walking into a glass door. And then you passed out for 15 seconds.

Those are the facts and now we’d like to relay some facts to you.

See, we were hoping you’d see this as an ideal way to reach all your fans, warning them of the dangers of concussions, even though the incident might have seemed like an insignificant injury to you.

But no, you and your manager both succeeded in sweeping the situation under the proverbial rug.

Here are some tidbits from your tweets, along with our commentary about the facts:

“im fine. just smacked my head”
No, a concussion is more than smacking your head. It’s when your brain gets knocked against the inside of your skull.

“needed some water. all good.”
No, Biebs, a concussion is not the same as dehydration.

“jb is gonna be fine. things happen. he is a trooper. canadian hockey player. tough kid. no issue.”
No, JB’s manager, concussions are serious issues, and they have nothing to do with being tough. Even the toughest of the tough have been sidelined by concussions, and that includes Canadian hockey players.

Oh, and by the way, the fact that you’ve been on Twitter since your concussion has not escaped us. Part of allowing your brain to rest is staying away from computers, cell phones, video games and the like. Yes, that includes dancing around. Not fun but very important.

So, Justin, please know that concussions are no small matter and we appeal to you to tell your fans the facts.

In the meantime, we have some advice for you: When In Doubt, Sit It Out. And watch those doors.

Sincerely,
HeadFirst

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