Girls frequently play soccer through concussion, study finds

McKenna Princing UW Health Sciences/ UW Medicine

Serious risks are associated with continuing game play immediately after incurring a concussion, yet University of Washington researchers found that many young female soccer players do just that.

Dr. John O’Kane, UW professor of orthopedics and sports medicine, and Dr. Melissa Schiff, professor of epidemiology and director of education at the Harborview Injury Prevention and Research Center, had parents make weekly online reports about any concussion symptoms their daughters experienced. They determined that a majority of players stayed on the field after experiencing concussion symptoms, and half never sought medical care.

The findings are reported Jan. 20 in JAMA Pediatrics. The study was supported by a grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases.

“Unlike a sprained ankle, concussion symptoms like a headache or dizziness often don’t physically prevent an athlete from continuing play, even though they’re putting themselves at risk by doing so,” O’Kane said.

Part of the problem may be that many concussed players don’t recognize symptoms. Concentration problems, headache, and dizziness were the most commonly reported symptoms in the study. More obvious symptoms, such as loss of consciousness, were least common.

Playing through concussion makes people more vulnerable to getting hit again, and having longer and more severe symptoms. A second blow can cause a rare condition known as second-impact syndrome, which can result in severe injury or death. Second-impact syndrome typically occurs in people under 20, O’Kane said.

He and Schiff found a higher rate of concussion among middle school soccer players than has been reported among high school and college soccer players.

“Young athletes who get a concussion tend to underreport or minimize it because they don’t want to be taken out of play,” Schiff said. “Unless they tell their coach about it, coaches often aren’t aware of what happened.”

Luckily for Kristina Serres, a high school soccer player, her coach noticed she was feeling disoriented after back-to-back impacts and took her off the field immediately.

“I felt dizzy and disoriented, and was wobbling around,” Serres said. “My mom said I was slurring my words and would stop in the middle of what I was saying.”

The next day, she went to the UW Medicine Sports Medicine Center, where O’Kane diagnosed a concussion and prescribed rest.

Serres had experienced two types of head blows common in soccer: a collision with another player and redirecting the ball with her head. Schiff and O’Kane found that, among study participants, more than half received concussions from contact with another player, and 30 percent occurred when players headed the ball.

Findings are mixed about whether heading causes concussion. The researchers speculated that heading may pose a greater risk to the middle school players due to factors related to their development, such as less neck strength and less mature brains, and poorer heading technique.

“It may be beneficial to teach proper heading techniques to younger players, and there may be situations where those players shouldn’t head the ball,” O’Kane said.

Schiff and O’Kane emphasized the crucial role education plays in preventing concussed players like Serres from returning to the game and reinjuring themselves.

“We need more education for children, as well as parents and coaches, about what a concussion is and what the consequences can be if it isn’t taken seriously,” Schiff said.

Note to reporters: A copy of the JAMA Pediatrics paper is available to the news media at http://media.jamanetwork.com/

Note to readers: The citation for the scientific paper is: JAMA Pediatr. 2014; doi: 10.1001/jamapediatrics.2013.4518. JAMA Pediatrics