Female Athletes and Concussions

Jeanne Brown, MS, ATC-L

OakLeaf Concussion ClinicEau Claire, WI

Concussions (male and female) account for 13.2% of all injuries

(1.6 – 3.8 million) per year…..epidemic proportions according to the CDC

2012- Marar M, Comstock RD – Am J Sports Med

Fewer overall than males, but increasing over time

Games riskier than practices

Higher rates for females in comparable sports and greater percent of total injuries

Much sex similarity, and modest sex difference shown so far in risks, symptoms and effects

For the Female Athlete:

Role of hormones:

Anatomy -Smaller head than male counterpart -Weaker neck muscles, less neck mass

Females have a higher incidence of headache and/or migraine making them more susceptible to concussion

Style of play: - Not anticipating blows - Head not on a swivel

Physical Risks for Female Athletes

Illegal Play is a Risk Factor for female athlete concussions:

- 6.4% of all HS sports related injuries were related to illegal play

- 14% in girls’ basketball - 11.9% in girls’ soccer - Concussions 25.4% d/t illegal play compared to 10.9% in males - Injuries to head/face 32.3% d/t illegal play

compared to 13.8% in males

Ethical Risks for Female Athletes:

Good news for the game and the coaches…. Bad news for injuries This will prevent them from reporting as they

imbibe in the culture of playing at all cost and playing for ‘the team’.

They are concerned about not being tough enough and about losing their position on the team.

They know the implications of sustaining a concussion – (they may lose weeks).

Girls are becoming more aggressive and assertive in the way they play……………….

are females just better reporters?

Or……

The first line of defense for the injured athlete…..

Provides immediate care of the athlete and …

Provides intermediate follow-up care of the athlete

Knows the athlete as well as anyone providing care

May be determining RTP decisions

The Role of the ATC -

94% - by ATC’s 59% - by PCP < 3% - by Specialists (neurologist,

NeuroPsy)

63% - by 2 qualified HCP 87% - by ATC’s and PCP 7% - by ATC and Orthopod

Consider these numbers: (HCP initial Assessment of Concussion)

TIPS FOR ASSESSING THE CONCUSSED ATHLETE -

Consider the sport and it’s rate of concussion

blow or hit to the head or body and whiplash potential

signs of a blow or hit to the head (bumps, lumps, bruises)

3rd or 4th period/quarter implications

SUSPECT A CONCUSSION….

Complete History / Mechanism of Injury Balance Testing CGS (alone with the athlete/no parent) Neuro-psych testing VOR testing

A thorough exam:

Symptoms for females tend to be neurobehavioral and somatic in nature

Females report more symptoms than males

Females have greater sensitivity to subtle symptoms

Females report more drowsiness and fatigue

Preliminary evidence (separate slides below?):

Preliminary Evidence cont….

• Females in general more likely to suffer from migraine before concussion which predisposes them to concussion, and they tend to have more headaches after they have recovered from concussion

• Elevated risk of mental health disorders: mood disorders, depression, sadness, irritability, anxiety (estrogen?)

• Auditory sensitivity and acuity: hence more phonophobia and tinnitus

Clusters of Symptoms:

Neuropsychiatric- More emotional-Sadness-Nervousness-Irritability

Cognitive Symptoms-Attention Problems-Memory dysfunction-”Fogginess”-Fatigue-Cognitive slowing

Sleep Disturbance-Difficulty falling asleep-Sleeping less than usual

Migraine (Physical SX)-Headaches-Visual Problems-Dizziness-Noise/Light sensitivity-Nausea

Every concussion is unique SF at rest, SF under exertion, Passing NP test and

VOR/Balance tests for Clearance considerations Treat according to symptoms : (4 clusters) Vestibular therapy if dizziness symptoms after 3

weeks Neck ROM exercises in conjunction with rest Neck Strengthening exercises with exertion Medications PRN : Aleve, Tylenol, and/or Excedrin

Migraine as OTC meds; Amantadine or Amitriptyline as RX meds

Academic accommodations: see handout Include social interactions via multi- media

Treatment Spectrum:

Treatment of Symptoms (based on cluster):

Emotionality• SSRIs

• Escitalopram (Lexapro)• Sertraline (Zoloft)

• TherapySomatic Symptoms• Headaches Prophylaxis

• Propranolol*• Verapamil*• Amitriptyline*• Escitalopram (Lexapro)• Sertraline (Zoloft)

• Vestibular Therapy

Sleep Disturbance• Melatonin• Trazodone

Cognitive Symptoms• Neurostimulants

• Amantadine*• Methylphenidate*• Atomoxetine (Strattera)*

EDUCATION! Rule changes necessary to protect the

athlete Teach and coach: head on a swivel,

anticipation of a blow Neck strengthening Headgear?

Prevention:

Video by UWEC

Neck Strengthening

The rate of concussions in females is high and on the rise

Consider the possibilities especially in high-risk sports (soccer, lacrosse, basketball, hockey)

Do a thorough assessment Treat according to cluster of symptoms Consider prevention parameters The Athletic Trainer’s role is paramount in the

assessment, treatment, and return-to-play decisions

Summary

Handouts available with resources

Justin Greenwood Diane Wiese-Bjornstal and the Tucker

Institute of Research: University of Minnesota

UWEC ATEP staff UWEC ATEP students who helped with the

video portions of this presentation

Thank you