Youth sports concussion clinics operate at the center of America’s heightened awareness and increasing worry about concussions among young athletes. Listening to the hundreds of stories of how concussions have occurred, examining patients and monitoring their recoveries, the doctors and staff members are a repository of anecdotal and medical concussion information.Here are some of their observations after watching the concussion phenomenon from the inside. Although it is not clinical data arrived at scientifically, it is meant to capture a picture of general findings.
Female patients are making up a larger percentage of the clinics’ overall concussion patient population, a percentage that continues to rise year to year.
“People used to say this was happening because female athletes are more likely than male athletes to report their concussion symptoms, but not many of us believe that is the reason any longer,” said Dr. Cynthia Stein of Boston Children’s Hospital. “Female athletes are just as aggressive about wanting to stay on the playing field, but maybe their sports are getting rougher.
“Forty-one percent of our new patients are now female, which is a huge amount when you consider that the No. 1 sport causing concussions is football, and that’s nearly all male.”
There are numerous theories about why the female percentage of the concussion cohort is climbing. The one most frequently mentioned by doctors focuses on the anatomy of the female neck. Because a whiplash effect is often blamed for a concussion — a brain injury can occur just by having the head violently snap back without a blow to the head — the generally thinner, less muscular female neck is thought to be a factor in the rise in head injuries.
The sports that doctors cited as leading to the most concussions for females were soccer, ice hockey, field hockey, gymnastics, cheerleading and basketball.
“Lots of girls getting elbowed in the head in basketball,” said Dr. Walter Panis ofMassachusetts General Hospital.
Dr. Susan Kirelik, the clinical director of the Center for Concussion at the Rocky Mountain Hospital in Denver, added: “In soccer, it is heads hitting the goal posts, heads hitting the ground and head-to-head contact. Very common in women’s soccer.”
Many concussions seem to result from a hit the young athlete does not see coming. It is not just blindside hits in football; it is collisions in which only one party is braced for the collision, as seen in sports with checking, like lacrosse and hockey. Many soccer players are injured when they are hit in the head by a kicked ball at close range that they did not see coming, especially blows from the side or behind them.
Doctors again have theorized that girding the neck for a collision or a blow to the head could be the body’s way of protecting the brain. If the blow comes without warning, that layer of fortification is not engaged.
“As coaches always say, ‘Keep your head on a swivel so you know what’s going on around you,’ ” said Dr. Michael O’Brien at Boston Children’s Hospital. “It might be good advice for a lot of reasons.”
There is no documented evidence that America’s intensifying youth sports culture is leading to more concussions. But several doctors said they thought the year-round schedules that millions of young athletes on travel and elite teams keep as they specialize in one sport was a contributing factor.
“They certainly play more games than ever and more games at a higher level of competition,” said Dr. Kevin Walter of the concussion clinic at the Children’s Hospital of Wisconsin. “They extend themselves more than ever. And with all the specialized training, they are bigger, faster and stronger. It adds up.”
Helmets, specialized mouth guards and headbands do not prevent concussions.“There is no known way to prevent concussions,” Stein said. “We love helmets and mouth guards; they protect your skull and your teeth. But they won’t stop a concussion from happening.”
While there is continuing research being conducted across the nation aimed at proving whether multiple concussions in a short period of time — or a lifetime — can lead to long-term or even permanent brain damage, doctors at Boston Children’s Hospital have recognized a pattern while studying lab mice subjected to repeated head trauma. The mice are analyzed as they perform various functions in a maze.
“We have seen there is a vulnerable time period, a certain distance between injuries that make things better or worse,” said Dr. Rebekah Mannix, one of the researchers. “We might be able to get to the truth — when it’s been a long enough time that even another concussion will not set me back in a permanent way.
“But we’ve also seen the other side with the mice. I hope they’re not predictive, but once they lose their cognitive abilities, it’s a lifetime thing. They don’t get it back.”
