Most of us watched with amazement (at least I did) during the World Cup as the soccer players used their heads and feet to make goals. (I will not discuss the Brazil team.). We have also been bombarded with information about concussions, especially in male football players. I suppose that butting the ball with one’s head in soccer is not brain protective. An article in the clinical review of JAMA at the end of August caught my attention. It was titled “Concussion and Female Middle School Athletes”. There were definitions of concussion, a list of health implications of concussion and statistics that I thought were highly informative for many of us as we watch our daughters and the daughters of our friends and family engage in this “getting more popular” sport.
A concussion in sport is defined as a process that affects the brain as a result of traumatic forces. (Well that part is clear.)
There are five features that characterize a concussion:
1. A direct blow to the head a blow to the body that transmits and “impulsive” force to the head.
2. This results in a rapid onset of short lived neurologic impairment that resolves spontaneously.
3. The clinical symptoms may or may not include loss of consciousness.
4. No abnormalities are seen on imaging studies.
5. The symptoms may be prolonged in a small percentage of cases.
Among high school athletes, concussion rates are highest in boys football and girls soccer. And in similar sports girls have higher rates of concussions then boys. Apparently female sex is a risk factor, so is prior concussion, young age and a history of migraine headaches. Symptoms include headache, dizziness, mental fogginess, difficulty concentrating and remembering and fatigue. Loss of consciousness occurs in less than 10% of concussions and the typical recovery time for an adolescent athlete is 7 to 10 days. (But the article noted that for some individuals, recovery may take weeks or months.)
In a report that was published in JAMA Pediatric a study, was done between 2008 and 2012 for soccer clubs in Washington state that involved 351 elite female soccer players from 33 youth soccer teams age 11 to 14. Among these girls 59 concussions occurred within over 43,000 athletic exposure hours. This meant that the cumulative concussion incident was 13% per season and the incidence was 1.2 per 1000 athletic exposure hours. “Heading” the ball counted for 30.5% of the concussions and most players continued to play with symptoms!
Perhaps the most concerning part of the report pertained to potential long-term effects of concussion. These include persistent deficits in memory and visual processing, decline in academic performance, depression, dementia and postconcussion syndrome (the symptoms last longer than three months) as well as second impact syndrome. That means that if another concussion occurs it can cause rapid brain swelling and this can be fatal!
The good news is that there is now legislation in all 50 states requiring schools to have protocols in place for concussions. They are supposed to have educational materials and guidelines for athletes, coaches and parents and the parents and athletes have to sign informed consent acknowledging the dangers of concussion before participation in sports. Any student who shows signs of concussion must be evaluated and cleared by a healthcare professional before being allowed to return to practice. However, unlike many high schools where athletic trainers are trained (we hope) to evaluate and manage injuries, youth sports leagues rarely have any type of medical coverage on site.
Since I knew so little of this information, I thought it was worthy of being shared…my conclusion is that parents need to be aware of concussion risk and engage in discussions with their daughters’ coaches. And just perhaps, encouragement to play tennis, swim, dance or go out for track is in order…