High school girl athletes face a higher risk of concussions than their male counterparts—especially soccer players, according to a recent study.
The study, which will be published in the Journal of Bone and Joint Surgery, was presented last week at the annual meeting of the American Association of Orthopedic Surgeons.
In the study, researchers looked at injury data from the High School Reporting Information Online injury surveillance system between 2005 and 2015. They compared injury data for nine sports, including boys’ basketball, football, wrestling, soccer and baseball; and girls’ softball, volleyball, basketball and soccer.
There were 40,843 injuries in this time period, with 6,399 concussions. During the 2014-2015 school year, concussions in girls’ soccer were more common than concussions in any other sport.
Dr. Wellington Hsu, an associate professor of orthopedic surgery at Northwestern University, and the lead author of the study, said that one explanation might be that girls’ neck muscles are less developed than boys’, so they rebound less quickly from the impact.
“The concussion occurs because of the shaking mechanism of the brain in the skull,” explained Dr. Joel Brenner, the medical director of sports medicine at the Children’s Hospital of the King’s Daughters in Norfolk. Strengthening the neck creates a bigger mass, which helps stabilize it upon impact, he added.
Hsu also said girls might be getting more concussions because they don’t learn proper techniques for heading—hitting the ball with their heads—early on. U.S. Soccer regulations mandate that kids—both boys and girls—cannot learn or engage in heading until they are 11 years, old, and then only for 30 minutes of weekly practice time.
“My daughter is 11 now, and she has no idea how to head a ball,” Hsu said, arguing that teaching heading earlier is better than waiting. “If girls don’t know how to head a ball, they may incur more injuries.”
According to Brenner, most girl soccer players with concussions have not been injured heading the ball, but rather from hitting the ground, another player or the goalpost.
Brenner also sees a lot of cheerleaders who have gotten concussions from being dropped, or hitting their heads against the ground or another person. He also sees many field hockey and lacrosse players with concussions.
Part of the reason for the rise in concussions in girl athletes may be an increasingly aggressive style of play, Brenner said.
Dr. Stephen Miller, a sports doctor with the Virginia Institute for Sports Medicine in Virginia Beach, agreed.
“Women’s sports are becoming just as aggressive as men’s,” Miller said. “More aggressive play makes for a higher risk of concussion.”
Miller added that 50 percent of his patients are high school girls, and many are soccer players.
Miller and Brenner both said that strengthening girls’ neck muscles might be a good preventive measure, and Brenner advocates for mindful, if not less aggressive play. The mantra he gives all athletes is: “Don’t sacrifice your brain for the game.”
Hsu hypothesized that lack of protective head gear might also be causing the surge in soccer concussions. Miller pointed out, however, that football players wearing helmets still get concussions.
Another main finding in Hsu’s study was that the overall rate of concussions in all sports increased after the introduction of youth sports’ traumatic brain injury laws throughout the U.S. in 2010. These laws make it mandatory to report concussions, remove players with concussions from games and monitor them before letting them re-enter games.
Hsu said this legislation has increased the diagnoses of concussions that had previously gone unreported. “Medical professionals are looking for this more,” he said.
His study showed that especially during the years following traumatic brain injury law enactment, the rate of girls’ soccer concussions was higher than that for boys’ football concussions.
Miller hypothesized that girls are perhaps more inclined to report their symptoms than boys. He would like to see a study that probes the possible reasons for this gender divide.
Hsu said he wants to do research on potential biomarkers that can help track athletes who have suffered concussions. Adolescents are more prone to a higher rate of re-injury and long-term neurological problems.