Study: Concussions on the rise, especially in girl soccer players

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One explanation for higher risk of injuries might be because girls’ neck muscles are less developed than boys’, so they don’t rebound as quickly from a blow that causes a concussion, said Dr. Wellington Hsu, the study’s lead author. (Photo courtesy of WYDaily)
One explanation for higher risk of injuries might be because girls’ neck muscles are less developed than boys’, so they don’t rebound as quickly from a blow that causes a concussion, said Dr. Wellington Hsu, the study’s lead author. (Photo courtesy of WYDaily)

In the past six months, the Hammerheads Youth Soccer Club has had two concussions—one in a boy and one in a girl, said Executive Director Carson Porter.

This ratio is pretty much par for the course in terms of the club’s concussions, which happen rarely in the club of 3,000 players aged 4-18.

Both players hit their heads to the ground. Porter recalled that the 14-year-old boy hit the back of his head, after which he held his head and said he had a headache. He was also discombobulated, Porter said.

“He was unaware of where things were: where the field was, the goal was, the street was,” he added. “That was a very easy call that this guy was not going back on the field.”

At least, not for a few weeks. The player was sent to the doctor, and over the next few weeks, he took baby steps to get back on the field. The first step was going back to school; then he could go for a walk; then a jog; then skill work with the ball on his own, Porter said.

If the same situation had happened a decade or two ago, the player might have just shrugged it off—something the coaches most likely would not have questioned. But concussions are taken very seriously these days.

“The old-school culture of ‘shake it off, you’re going to be fine,’ is not the message that we give to our coaches,” Porter said. “We are getting away from that mentality because we do see the seriousness of these injuries.”

Increased awareness of concussions

Concussions have been in the spotlight because of the potential long-term health effects like cognitive and neurological issues. Professional league players such as Taylor Twellman and Cindy Parlow suffered concussions that ended their careers early, and such situations have led to an increased awareness of the risk of soccer.

As a result, since 2007, all states have enacted youth sports’ traumatic brain injury laws, mandating the recognition and removal of players with concussions, as well as a physician’s approval for when they can play again.

Since these laws, reported concussions in youth sports have increased. A recent study showed that between 2005 and 2015, there were 40,843 injuries across nine youth sports, and 6,399 concussions.

The study also found that of those nine sports—including boys’ basketball, football, wrestling, soccer and baseball, and girls’ softball, volleyball, basketball and soccer—girls soccer players suffered the most concussions compared to the other groups of athletes.

Dr. Wellington Hsu, an associate professor of orthopedic surgery at Northwestern University, led the study, which will be published sometime this year in the Journal of Bone and Joint Surgery. Hsu presented it at the annual meeting of the American Academy of Orthopaedic Surgeons a few weeks ago.

Reasons why girl athletes get more concussions

Hsu said one reason for the increase in girls’ concussions is that their neck muscles are not as developed as boys’, so they don’t rebound as quickly from a blow to the head.

Dr. Karl Ziermann of Wilmington Health, who treats a lot of adolescent athletes for concussions, said there’s “decent data” that girls are more at risk for concussions because they have less neck strength.

Ziermann said the trend could also reflect the increased participation of girls in competitive sports like soccer.

“Girls have a wonderful opportunity to play sports as much as boys,” he said. “One of the side effects is that they are more risk of injury, and concussion is one of those injuries.”

In his own clinic, Ziermann treats just as many girls as boys soccer players, but boys football players probably have the most concussions, he said.

“I think football players have a higher rate of concussions, but we’re seeing more soccer players because there are a lot more people playing soccer,” he said.

What Ziermann worries about most—and cautions kids against—are repeat concussions. The younger you are, and the more concussions you have, the more at risk you are for complications from concussions, he added. When kids start to come with two or more concussions, Ziermann said he often initiatives “very difficult conversations,” advising them against continuing to play the sport. Sometimes, he said, the kids—or their parents—don’t like his advice, and they don’t come back.

Heading rules change

 To help prevent concussions, U.S. Soccer a couple of years ago enforced new rules about heading the ball—when players use their head to pass the ball. Kids under age 11 are not allowed to head the ball at all, and those between the ages of 11 and 13 can head the ball for 30 minutes at practices, but not in games.

Porter said he generally agrees with these new rules, but he also worries that kids might pick up heading on their own, incorrectly.

“Children at young ages were sort of exposed to heading the ball,” he said. “Now that’s gone.”

Hsu agreed.

“My daughter is 11 now, and she has no idea how to head a ball,” he said, adding that because of his concern over potential injury, he is teaching her how to head the ball on his own.

Porter said they still teach kids to head in the same, safe way—with their foreheads, the thickest part of the head. “If you head the ball on the top of the head, that’s softer spot. That has a chance of a bigger impact than the forehead.”

Since the new rules, some coaches have begun using balloons or volleyballs as a way to ease kids into heading, he added.

But by and large, the way kids learn to play soccer hasn’t changed, Porter said.

“First they learn how to pass, receive the ball, dribble,” he said. “Nobody plays soccer to head the ball. It’s important, but probably the last skill that they learn.”