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Your Daughter’s Brain and Soccer; Here’s What You Need to Know

The movie “Concussion” is based upon the extraordinary story of Dr. Bennet Omalu. Dr. Omalu was determined to understand why so many American football players, young and old, suffer from dementia type symptoms that closely resemble Alzheimer's’, but also branch into depression and erratic behavior.   

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When football player, Mike Webster, died, Dr. Omalu promised himself he find out what had been wrong with him.  He took Mr. Webster’s brain home with him for six months, studying slide after slide until he discovered a new disease, chronic traumatic encephalopathy, which results from repeated impacts to the head.

Famous dads, from basketball player LeBron James to former Chicago Bears Coach, Mike Ditka, have made headlines saying they wouldn’t let their sons play football, but there’s less hand-wringing out there about girl’s soccer, which has been called the second most injury prone sport after football.

Girls’ soccer is on the rise, most recently boosted by the U.S. women winning the 2015 World Cup. U.S. Youth Soccer reports that girl’s club soccer participation has risen nearly 40% in the last 20 years. FIFA claims that, worldwide, 30 million girls play organized soccer.

There’s a lot to love about girls’ soccer. As author Hilary Levey Friedman states in her book, Playing to Win: Raising Children in a Competitive Culture, for many parents, girl’s soccer is not just about athleticism, it also teaches girls the confidence and team player mentality that lead to success in later life.  

As one mom told Friedman, “I think when you play a sport, I think it teaches you assertiveness, because you can't just wait for the ball to come to you. You have to go for that ball."

Going for the Ball -- and Head Injury

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Soccer players experience head trauma primarily in two ways -- collisions with each other and heading the ball.  Comstock recently evaluated data from 3 million soccer games from 2005 to 2014.  Their data broke down concussions by gender.

They found that 68% of boy’s concussions and 51% of girl’s concussions resulted from player to player contact.  Heading the ball also contributed to a large percent of concussions, explaining 17% of concussions among boys, and 29% of concussions for girls.

So, both boys and girls are at risk of concussion when playing soccer.  What’s potentially both troubling and surprising about the data are some of the differences between boys and girls.

Girls suffer concussions at a higher rate than boys who are playing the same or similar sports. A 2007 study discovered that the concussion rate for girls was 60% higher than it was for boys. A later 2011 study reported that the concussion rate for girls is 1.7 times higher than it is for boys.   In other words, girls’ concussion rate, at 4.5 per 10,000 school sanctioned games, in soccer is nearly double that of boys, making girl’s soccer the most second dangerous kids’ sport after football.  

Are Girl’s Frontal Brains Different?

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The evidence shows that soccer has risks both for girls and boys; it’s why U.S. Soccer, the governing body for the sport in the United States recently recommended that children under 10 should never head the ball, and those between 10 and 13 should only do it in practice.  This should help, although parents should remember that at least half of soccer concussions result from person-to-person contact.

As any parent knows, being told your daughter is too delicate for a sport can feel patronizing. Still, there’s something about girls’ brains and head injury that remains mysterious.  

Canadian researcher Sandra Witelson, has shown that female’s frontal brains contain 18% more nerve endings than male brains. Dr. Jay Giedd has called the frontal lobe, the “CEO” of the brain, because it is involved in planning, organizing, initiating and shifting attention. In addition, some say that the female frontal brain explains females’ dominant language skills compared to males.  

Dr. Dave Ellemberg, a brain injury researcher at the University of Montreal, compared 10 female college soccer players who had suffered a single concussion with 10 who hadn’t, finding evidence of cognitive impairment 6 to 8 months after their injury.

Curiously, while verbal skills weren’t impaired, the test group was slower to make decisions for a complex problem and showed problems with task switching, both capabilities said to be controlled by the frontal “CEO” portion of the brain. Dr. Ellemberg also posits that differences in girls’ head and torso muscles may mean that girls cannot absorb a blow to the head and neck as well as boys.

While the difference between male and female brains (and bodies) is a controversial topic, it’s worth wondering whether girls simply have more at risk than boys when playing soccer.

Recent Research on Girls and Head Injury

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The scientific community has not yet provided a definitive answer to why girls get more concussions than boys, but they have learned a few things about head injury and gender.

Researchers at the University of Michigan in Ann Arbor set out to understand whether concussions affect men and women differently. Their study looked at 148 college athletes from 11 different sports at the University of Michigan in Ann Arbor.

These researchers found that neither men nor women appeared to test worse based solely on the fact that they had a concussion in the past.  However, they found that the women in the group suffered more symptoms from their concussions than the men.

Women reported on average 1.5 more symptoms, and they scored symptom severity that is three points higher than the male average. During a clinical reaction test, women were 19 milliseconds slower to react than men. Women also scored on average 7% below men on cognitive tasks that assessed processing speed, memory, and attention after suffering a concussion.

The authors couldn’t fully explain this finding, stating that these gender differences require further investigation.

It’s not just concussions that are suspect but minor bumps may matter too.  A study of high school female soccer players tested girls’ cognitive skills soon after heading the ball and found that even without a concussion, the cognitive effects of impact were consistent with mild traumatic brain injury of the frontal lobes. The girls in the test group were worse than the control group (who played soccer without the head impacts) at performing voluntary reflexive tasks. Further study is needed to know whether these are long-term effects.

A third study, published online in the journal Radiology, seems to indicate that women may have a more difficult time than men in recovering from a concussion.  The study set out to evaluate the gender differences by using functional magnetic resonance imaging (FMRI). This allowed the researchers to analyze brain patterns while the participants completed working memory tasks.

"In clinical practice, more women than men seek medical attention due to persistent symptoms after MTBI at a ratio of almost 2:1," said lead study author Dr. Chen, M.D. "We started to wonder whether there might be differences in MTBI outcomes between men and women."

"Difficulty with working memory is a commonly reported impairment after MTBI," Dr. Chen said. "Since working memory is important for a wide variety of cognitive skills, compromised working memory could have significant effects on everyday life." The researchers studied 30 patients with concussion and 30 control patients. Groups had an equal amount of men and women. The patients undertook one exam with a month of the injury, followed by an exam 6 weeks after their first scan. These tests measured the patient’s impulsivity, attention span, and memory.

The results of the tests indicated that women experience concussion differently than men. At the first exam, men showed increased activation and women showed decreased activation. At the follow-up exam, men had returned to a normal pattern, whereas women showed persistent hypo-activation.

These findings have produced evidence that women are more likely to suffer memory problems after a concussion. These findings could result in better treatment for women who have suffered from a concussion. While this research backs up earlier studies that indicate concussion affects women more than men, Dr. Chen cautions that further research must be done to validate these findings.

What’s a Soccer Mom (or Dad) to Do?

Girls Brains and Soccer, Bloomwell - Wills, Trusts, Medical Consent Forms

Soccer is one of the great American pastimes.  It can be disappointing for any parent to realize that soccer, which teaches girls how to be stronger and more competitive both on and off the field, may also have real risks.  

Better research is on the way.  While the NFL recently backed out of long-term studies, the National Institute of Health and the ICHIRF (International Concussion and Head Injury Research Foundation) plan to fund further research into the potential long-term effects of concussion in sports.

In an essay titled, “Soccer Broke my Brain,” former soccer player, Rebecca Ruiz, tells her own story of giving up the game she loved after a concussion. As a reader, you can sense both Rebecca’s appreciation for the joys of the game and her grief over the trauma of head injury.  

More protective headgear and better training may reduce risks over the long term.  In addition, U.S. Soccer’s ban on heading for kids’ takes away at least some of the concussion risk, arguably making the sport a safer bet for girls under 10.  

Parents should work to influence soccer culture and how the game is played.  Since most concussions come from body impact, culturally, parents should encourage coaches to emphasize skill, speed, and tactics and not encourage soccer games that emulate the fast and hard body contacts of football.

If anything, the evidence and the number of questions yet unresolved about girls and soccer are a cautionary tale about giving our kids the athletic opportunities that will make them stronger, but also keeping a careful eye on the developing research about impact sports and the brain.

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References:

American Academy of Neurology. "Does concussion impact men and women differently?." ScienceDaily. ScienceDaily, 25 July 2015. 

American Academy of Pediatrics. "Basketball, soccer, lacrosse lead to most ACL injuries among high school female athletes: New study breaks down rate of injury to major knee ligament per season by gender and sport." ScienceDaily. ScienceDaily, 23 October 2015. 

Frommer L, Gurka K, Cross K, Ingersoll C, Comstock R.D., Saliba S. Sex Differences in Concussion Symptoms of High School Athletes. J. Ath. Train, 2011; 46(1):000-000

Gessel LM, Fields SK, Collins CL, Dick RW, Comstock RD. Concussions Among United States High School and Collegiate Athletes. Journal of Athletic Training. 2007;42(4):495-503.

Marsha R. Zhang, Stuart D. Red, Angela H. Lin, Saumil S. Patel, Anne B. Sereno. Evidence of Cognitive Dysfunction after Soccer Playing with Ball Heading Using a Novel Tablet-Based Approach. PLoS ONE 8(2): e57364. 27 February 2013

SP Chrisman and LP Richardson. Prevalence of diagnosed depression in adolescents with history of concussion. Journal of Adolescent Health, January 2014

 

 

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