Unclear why concussions more likely among girls


October 05, 2007|By MILTON KENT

Sarah Mosier has seen enough concussions among her teammates in club soccer to know that they can be part of the game. Mosier said one of her club teammates suffered so many blows to the head that a doctor stopped her from playing. Worrying about concussions had never been part of Mosier's game plan, however.

That is, until she experienced dizziness after taking an inadvertent kick to the head in an August scrimmage.

"I came back to practice thinking everything was going to be OK," said Mosier, a senior goalkeeper with second-ranked John Carroll. "I didn't think much of it."

Mosier, who was kicked in the head during a Thursday match, made the save on a breakaway and finished the game, albeit with a headache and dizziness that lasted into the evening.

Mosier tried to practice the next Monday but left when a trainer recommended that she see a doctor. The next day, the doctor told her not only that shouldn't she have been playing, but also that she should have been sitting indoors in air conditioning, as the late summer heat would only raise her blood pressure and "mess with my brain and everything."

Mosier's experiences are consistent with those in a study by Ohio State and a leading Midwestern hospital that indicate that high school girls who play soccer and basketball are much more likely to suffer concussions than their male counterparts.

The study, which will appear in the winter edition of the Journal of Athletic Training, was conducted by a team of researchers from Ohio State and Nationwide Children's Hospital in Columbus, Ohio. The findings were first reported in The New York Times.

The research team focused on injuries to athletes from 100 high schools around the country and 180 colleges during the 2005-06 school year. The collected data covered nine sports - football, soccer, basketball, wrestling and baseball for boys, and girls soccer, volleyball, basketball and softball - and centered on injuries that required medical attention and the injured player to miss at least one day of play or practice.

The survey identified football, boys and girls soccer and girls basketball as the four sports with the highest incidents of concussions, which are disturbances in the function of the brain because it has been violently shaken or jarred.

Within those numbers, the data indicated that girls who played soccer suffered concussions 68 percent more often than boys who played the sport, while female basketball players suffered concussions at a rate nearly three times that of male players.

Researchers and medical professionals have zeroed in on two explanations - one practical and one theoretical - for the discrepancies in concussion rates between boys and girls, particularly in sports that both sexes play.

The practical reason is, in general, the neck muscles of a high school boy are better able to support the head when it is jarred.

"Women don't have as much testosterone and growth hormones as men," said William H.B. Howard, medical director emeritus of Union Memorial Hospital's Sports Medicine Center. "The neck muscles of a guy are stronger and can support the head better than a girl's from [contact with] another head, or knee, or elbow or the ground."

The other rationale for the concussion disparity is a theory among medical professionals that girls are more likely to report their injuries than boys are. Although that explanation might work in studies or in theory, many who are personally involved in the games don't agree.

"If you get a girl that's really competitive, they don't run off when they break a fingernail, like you might think," said Gary Lynch, in his 11th season as girls soccer coach at John Carroll.

"These kids are players. If you get to [be one of] the top soccer players, if you think they want to come out of the game, they're like the boys. You've got to tell them they have a concussion. They're not going to come over and tell you. ... It doesn't work that way. It sounds like an easy excuse, an easy reason to make up why there's more girls than boys, and I don't buy it."

Though people might disagree why there is a concussion disparity, they agree there are no firm answers on how to resolve it.

For one thing, many of the signs of concussions - headaches, dizziness, nausea, inability to retain information or difficulty focusing on a conversation - are just as attributable to other conditions, so as to make recognizing an injury difficult to a parent or layperson.

"It can be a challenge with subtle concussions that aren't obvious, where somebody isn't laying on the field for a minute or two and have the obvious postconcussive symptoms," said Andrew Tucker, the Ravens' head physician.

Another problem in dealing with the matter of concussions among girls is how to balance making the games safer with rules changes or more protective equipment without reducing their competitive nature.

"Basketball players are always going to be encouraged to take a charge, said Tucker, who is also medical director at Union Memorial Sports Medicine. "People are going to go aggressively for the ball. Elbows are going to be flying; the floor is always going to be hard. I just think there's always going to be a certain low-level risk in certain of these sports that I'm not so sure that we can make significant differences in terms of reducing the risk."

Mosier, who was cleared to play a week after her diagnosis, acknowledged that she was nervous those first few practices after she returned, but ultimately worked past her fears because that is what athletes do.

"I really don't think about things in the past," Mosier said. "I've had shoulder injuries and I've had to put it behind me, and that's what I'm doing with this. I just like to play my game, and if something happens, it happens.'


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