Dangerous Head Games

It is estimated that there are 1.7 million sports-related head injuries annually in the United States — the majority of them are categorized as concussions. But get rid of the mental picture of a tough high school football player who just had his bell rung on the field.

According to recent studies, a petite girl in a soccer uniform is a more likely concussion victim. In fact, a study published in the Journal of Athletic Training shows girls in high school soccer sustained concussions 68 percent more often than boys. And female concussion rates in basketball were as much as three times higher than among boys.

Charlotte soccer-mom Mimi Kane takes this research quite seriously. Kane still winces at the thought of her 13-year-old daughter going up for her third header in a row during a soccer match in Washington, D.C., last year.

“She went down, hard,” says Kane. The athletic eighth-grader, a midfielder on one of the South Charlotte Soccer Association’s Premier Level teams, was taken out of play and did not hit the field again until the next day, when she had two games scheduled. She played one game and seemed in fine shape.

“During the second game, she asked to come out and felt dizzy and nauseous,” Kane says. Her daughter had a concussion. The Kane family flew home to Charlotte that night and the next day the concerned mother brought her daughter to the Carolina Sports Concussion Program at Carolina Neurosurgery & Spine Associates. Dr. David Weircisiewski, the program’s founder, administered the ImPACT test to gauge the severity of her daughter’s concussion.

Weircisiewski prescribed rest and monitoring for Kane’s daughter. All physical activity was curtailed, as well as activities that required intense concentration, such as tests in school.

“It was three to four weeks before I could catch a glimpse of my daughter again,” Kane says. “She was tired, groggy, loopy … she would go to school, come straight home and get in bed. But what really told the story were her grades. She was an “A” student until those few weeks, when things went down to about a “D” level.” Her daughter was suffering from post-concussion syndrome, a growing concern among doctors.

Diagnosis and Recovery
Improvements in diagnosis and increased awareness have brought concussions and the consequences of ignoring the injury to the forefront of sports medicine. In addition, a recent study at Ohio State University and Nationwide Hospital in Ohio has revealed that in high school sports, female concussion rates are substantially higher than those of their male counterparts. According to the study, the difference is based largely on physiological differences between males and females, such as neck muscle strength and head circumference.

Recovery times can vary depending on a host of factors. Age, a family history of migraines and suffering multiple concussions can all spell a longer recovery time than the typical seven to 10 days the general population can expect.

Injury Prevention
“Typically in soccer it is collisions that cause concussions, but I also see concussions from heading the soccer ball,” says Weircisiewski, who agrees with the Ohio study’s explanation that anatomical differences between men and women are one possible cause of the higher female concussion rates, or namely, weaker female neck muscles.

“One way to minimize the risk would be conditioning of the neck muscles,” Weircisiewski says. “Another thing that has been mentioned is the smaller head circumference or surface area. Any impact that the head has with a surface, whether that be a ball or a person, carries a higher impact ratio because of that.”

Assistant soccer coach Dan Laurie has played men’s soccer for 30 years and in that time has seen two concussions. In the last five months of coaching the South Charlotte Soccer Association’s 93 Girl’s team, he has seen six concussions. “Of course, I know of several girls’ teams with no concussions,” Laurie says, but admits that there might be something to the Ohio study.

The coach noted that boys begin heading the ball more aggressively at a younger age than girls, which might also contribute to the rash of injuries. There is headgear for soccer available but there is no testing that proves it works, Laurie says. But headgear and taking the ImPACT Test as a baseline before an injury happens might be the best defense.

Back in the Game
And then there is the good old fashioned “shake it off” factor. In traditionally male-dominated sports, players are regularly encouraged to shake off injuries, especially injuries in which there are no visible symptoms, like a broken bone or bruising. Women conventionally are more apt to talk about injuries as well as seek treatment if they do not feel well. The consequences for ignoring a concussion or multiple head injuries and playing sports before the brain has healed itself can be serious.

Repeat concussion victims are more prone to have persistent concussion syndrome, which consists of a constellation of symptoms including headache, dizziness, blurry vision, depression, anxiety and fatigue. These are all of the vague, nondescript symptoms you hear about people suffering as a result of playing professional football and other high contact sports. Another symptom that can develop is permanent cognitive impairment with a decline in memory, reasoning and decision making.

The hard part, says Weircisiewski, is knowing when a player has had too many concussions and needs to stop … everyone is different. Another rare side effect for concussion sufferers under the age of 21 is second impact syndrome. If a young athlete plays with a concussion injury and suffers a second concussion immediately after the first, in rare instances the second concussion can actually kill the athlete. The second concussion can cause a loss of blood vessel regulation and swelling in the brain that has a 30 to 50 percent mortality rate or can leave the athlete severely disabled.

“The problem with a concussion is that you never know if you did the right or the wrong thing right now … you only find that out 15 years from now,” says Weircisiewski. “The news (reports) about wrestlers and football players with cognitive issues, these injuries occurred probably a decade ago.”

Aletha Hart and Leslie Shiel are Charlotte-based freelance writers.

Related Articles:

> How do I know if my child has a concussion?
> Concussions: When to Worry
> More than a Bump on the Head