Wednesday, October 03, 2007
Concussions and girls
When you think of high school sports concussions, whom do you envision getting banged up? Usually it's a strapping young football player - a male - isn't it?

But in sports that both girls and boys play such as basketball and soccer, girls are more likely to suffer these dangerous brain injuries - more than 1 1/2 times in basketball and almost three times more likely in soccer. That's according to a new study published in the Journal of Athletic Training, which looked at high school students at more than 100 schools nationwide. And, girls take much longer to recover and get back on the field than boys do.

What I find even more intriguing are the possible explanations behind the surprising stats. On one hand, researchers point to biophysical phenomena - for instance, the fact that boys have stronger neck muscles and larger heads than girls, so they can tolerate stronger blows.

But there is also a sociocultural explanation: The suspicion that girls tend to report their concussion symptoms more than boys, and boys hold back when they may be feeling a bit dizzy or nauseated because they want to be tough and keep playing, despite the potential long-term dangers of getting hit again too soon. (By the way, those possible dangers are no joke: repeated concussions can lead to long-term loss of cognitive function and memory loss.) And as far as returning to the field - coaches, athletic trainers and parents tend to be more cautious about letting girls back on to the court or field, more so than with their male counterparts.

So what do you think? Does it seem more plausible that girls are more protected (by themselves and others), and that boys are allowed to be more aggressive and less cautious about these injuries? Or do you think it's just a physical thing? Or both? Or something else altogether?
This discussion is just begging for snide remarks about how much smarter girls are than boys and now we know why. However, it is an interesting observation. One explanation could be 'like mother like daughter/like father like son.' Women tend to pay greater attention to their bodies and are more apt to see a doctor about symptons of a possible illness and their daughter's are likely to follow suit. Alternatively and historically, men are much less likely to see a physician about a possible illness and their sons are doing likewise.
This doesn't seem to take into account that many boy's sports require large pads and helmets (football, lacross, hockey, etc.), but when girls the same age play the same sports, there's no helmet involved, maybe a mouth gaurd and that's it. Plus a lot of girls sports are more violent then you are giving them credit for, girls take it personally at that age, and they really go after each other. Then there's also the fact that girls out number boys in cheerleading and gymnastics, two sports that lead the pack in head injuries, if you fall from a decent hight and land on your head, it's going to cause dammage. You assume that boys do get more head injuries, they just aren't caught, or treated seriously, that's not what the data here is saying.
This discussion does bring a question to mind. How well do women in the sport of boxing hold up to blows to the head? I wonder if there is significant difference between that of men.
As a girl that suffered from numerous concussions over my athletic career in high school, I believe that brain injuries in females need to be studied much more in-depth than they have been in the past. It something that people just don't think of in female sports. Concussions in females are often treated like they are in men with the general mentality of 'shake it off.' As the New York Times recently reported, repeated concussions to females can lead to terrible damage that is often unreported, undiagnosed and completely unlike the symptoms of their male counterparts. I think that there are physical differences between male and females that make concussions completely different, but it is rarely accepted by society that females can be just as aggressive as males in sports that are less padded. A tackle in football will end far differently than a tackle in soccer. Many female athletes take what happens in a game personally, and will be violent about it, they are just about as likely to get up and continue playing after a concussion as many males are. I believe the main problem here is a lack of understanding by society and its norms. The amount of aggression by males and females is about equal but the physical differences between males and females result in entirely dissimilar effects from like injuries. I have never seen in my soccer career any more caution about sending females in to a game than males. (and most determined females will play down their symptoms and injuries to continue playing in the game.) I think that this is an issue that is long overdue to be explored, female brain injuries are not often taken into consideration, which could turn out to be a fatal flaw in the world of female athletics.
The situation described in this blog do not describe my experiences as a female engaged in sports. As a teenager and a young woman, I sustained several concussions, broken bones, contusions and sprains from extensive and intensive horseback riding activities. This means all of my head injuries were sustained as a result of being propelled and falling from over five and a half feet, albeit with some safety equipment (helmets and safety vests). None of the doctors who examined me took the concussion diagnosis seriously, other than to discharge me within a few hours of admission, with instructions for my parents to wake me every two hours overnight. Even when one of these injuries occurred when I was participating with a collegiate team, the college's doctors did not offer any form of follow up treatment, unlike a friend's boyfriend, who sustained a similar concussion in a football collision. I'm not sure if the perception was my injury (being propelled at twenty miles per hour by 1,000 pounds of animal onto my shoulder and head) was less "critical" than his injury (crashed into the head and shoulders by 220 pounds at 5-7 miles per hour), or if it simply was a generalization made by the medical community that I couldn't possibly have been as injured as he was. At the time these injuries happened, I thought it was because doctors did not understand the mechanics of horseback riding, but there is data out there regarding the frequency of serious injury in my chosen sport. As I've gotten older, I've cynically wondered if the real reason is because I'm a girl and the doctors just didn't think I could have played as rough as the guys did, and subsequently did not treat my conditions as aggressively. I would like to think the medical community in general would not take my gender into consideration this way, but I do have to wonder. Since so many medical research tests and studies in general are exclusively performed on men and male body function, anatomy and responses, it stands to reason the standard treatment response and options for head injuries may not take into account gender differences.
It took the medical establishment decades to realize women exhibited different heart attack symtoms from men and to include women in their research, rather than universally applying research results from men on women's treatment. Perhaps this is another case where medical treatment needs to mature some more and understand there really might be some differences in symptoms and responses to head injuries in women then the conventional information they already have from men.

C. Anne, Dover, NH
My 13 year old daughter is an athlete - volleyball, basketball, track, and horseback riding (western show). Frankly, girls are playing harder. I've seen girls get plowed over in basketball, bang heads in volleyball, fall on their face in track, and fall on their heads in the arena. Maybe girls are just done with being "fragile" and they're just playing harder, faster, and tougher. Concussions, sure...broken wrists, twisted ankles, black eyes...bigger, tougher, and smarter. You go girls!
Could it be a simple matter of playing rougher at a younger age. Boys are much more used to physical contact as a result of the more physical games boys tend to play when they are young. Maybe we simply learn to protect ourselves better, keep our head out of the way.
i would like to point out that when girls play sports that require helmets such as hockey and football, of course they wear helmets! the reason girls don't wear helmets in lacrosse is that it is nearly a different sport than boys' lacrosse. contact is limited; a tackle would result in expulsion from a game if not an entire season in girls' lacrosse.
As a girl playing high school soccer (and getting major concussions doing so) I think it is just guys generally wanting to tough it out. Girl get hit just as hard, but we are more aware of what's happening and if we're hurt. A lot of guys are competitive and just want to play, injured or not.
Women do play sports very roughly, we just don't admit it when we get hurt. Its ok for a guy to hurt a guy but its never feminie and so ok for a woman to hurt a woman. Bullying also goes unnodiced by thoses same reasons. Women do really get hurt more but we are still seen as delcate so if we have to be out of the game it must be major/ life threrating. But in womens sports a lot of people think oh that 250-300 pound 6 foot five female could never hurt that four foot 9 eighty pound girl cause well shes a girl! and does not have the strenght to. If it was a discrepance that large for male athelites they wouldnt even be playing agaist eachor. Let larger women play on the mens teams and let the smaller ones compete. Women also rarely see docters when we are ill as we are told oh it must be hormonal, or oh its just femine issues even if its nowhere near atime when that could be true. Its like in the victorian era femine histeria, if we say we are hurt its laughed off. get over this sexism and let women be known as mens equals in their ablity to be tough we may be a bit shorter and weight less but we have the same bmi and muscle, so lets us be treated the same in reagrds to injury
i've had 6 concussions. I'm a male and in high school. Suffering and experiencing headaches is part of daily life. I'm not some dumb-muscle-kid that plays football and does horribly in school, in fact school in my number one priority. I know that this article is about females and concussions but i think that regardless male or female. The seriousness and issues of concussions are far far overlooked. I think both males and females often don't report symptoms and instead of getting better, get a lot worse. I know this experience first hand. It changes your attitude, the way you think, your concentration, pretty much everything about you. Its incredibly serious and sometimes the only people that can understand what someone is going through is someone else who has been through it. Its the hardest thing ive ever experienced and im even experiencing headaches now. Doctor after doctor, drug after drug, the only true cure is rest.

Male or females - who's more physical? Doesn't really matter. Kids all over the country need to be educated about the seriousness of brain injuries and knowing when is the right time to stop.
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