1. Female Athletes and Concussions
Jeanne Brown, MS, ATC-L
OakLeaf Concussion Clinic
Eau Claire, WI

2. 2012- Marar M, Comstock RD – Am J Sports Med
Concussions (male and female) account for 13.2% of all injuries (1.6 – 3.8 million) per year…..epidemic proportions according to the CDC
2012- Marar M, Comstock RD – Am J Sports Med
Indications are that this number would be lower if all injuries that occur were actually considered as reportable (i.e. – minor injuries like mild ankle sprains that did not result in time lost of play are not included in the data)

3. For the Female Athlete:
Fewer overall than males, but increasing over time
Games riskier than practices
Higher rates for females in comparable sports and greater percent of total injuries
Much sex similarity, and modest sex difference shown so far in risks, symptoms and effects

7. Role of hormones:

8. Physical Risks for Female Athletes
Anatomy
-Smaller head than male counterpart
-Weaker neck muscles, less neck mass
Females have a higher incidence of headache and/or migraine making them more susceptible to concussion
Style of play:
- Not anticipating blows
- Head not on a swivel

9. Ethical Risks for Female Athletes:
Illegal Play is a Risk Factor for female athlete concussions:
- 6.4% of all HS sports related injuries were related to illegal play
- 14% in girls’ basketball
- 11.9% in girls’ soccer
- Concussions 25.4% d/t illegal play
compared to 10.9% in males
- Injuries to head/face 32.3% d/t illegal play compared to 13.8% in males

10. Girls are becoming more aggressive and assertive in the way they play……………….
Good news for the game and the coaches….
Bad news for injuries
This will prevent them from reporting as they imbibe in the culture of playing at all cost and playing for ‘the team’.
They are concerned about not being tough enough and about losing their position on the team.
They know the implications of sustaining a concussion – (they may lose weeks).

11. Or……
are females just better reporters?

12. The Role of the ATC -
The first line of defense for the injured athlete…..
Provides immediate care of the athlete and …
Provides intermediate follow-up care of the athlete
Knows the athlete as well as anyone providing care
May be determining RTP decisions

13. Consider these numbers: (HCP initial Assessment of Concussion)
94% - by ATC’s
59% - by PCP
< 3% - by Specialists (neurologist, NeuroPsy)
63% - by 2 qualified HCP
87% - by ATC’s and PCP
7% - by ATC and Orthopod

14. TIPS FOR ASSESSING THE CONCUSSED ATHLETE -

15. SUSPECT A CONCUSSION…. Consider the sport and it’s rate of concussion
blow or hit to the head or body and whiplash potential
signs of a blow or hit to the head (bumps, lumps, bruises)
3rd or 4th period/quarter implications

16. A thorough exam: Complete History / Mechanism of Injury
Balance Testing
CGS (alone with the athlete/no parent)
Neuro-psych testing
VOR testing

17. Preliminary evidence (separate slides below?):
Symptoms for females tend to be neurobehavioral and somatic in nature
Females report more symptoms than males
Females have greater sensitivity to subtle symptoms
Females report more drowsiness and fatigue

18. Preliminary Evidence cont….
Females in general more likely to suffer from migraine before concussion which predisposes them to concussion, and they tend to have more headaches after they have recovered from concussion
Elevated risk of mental health disorders: mood disorders, depression, sadness, irritability, anxiety (estrogen?)
Auditory sensitivity and acuity: hence more phonophobia and tinnitus

19. Migraine (Physical SX)
Clusters of Symptoms:
Neuropsychiatric
- More emotional
-Sadness
-Nervousness
-Irritability
Cognitive Symptoms
-Attention Problems
-Memory dysfunction
-”Fogginess”
-Fatigue
-Cognitive slowing
Sleep Disturbance
-Difficulty falling asleep
-Sleeping less than usual
Migraine (Physical SX)
-Headaches
-Visual Problems
-Dizziness
-Noise/Light sensitivity
-Nausea

20. Treatment Spectrum: Every concussion is unique
SF at rest, SF under exertion, Passing NP test and VOR/Balance tests for Clearance considerations
Treat according to symptoms : (4 clusters)
Vestibular therapy if dizziness symptoms after 3 weeks
Neck ROM exercises in conjunction with rest
Neck Strengthening exercises with exertion
Medications PRN : Aleve, Tylenol, and/or Excedrin Migraine as OTC meds; Amantadine or Amitriptyline as RX meds
Academic accommodations: see handout
Include social interactions via multi- media

21. Treatment of Symptoms (based on cluster):
Emotionality
SSRIs
Escitalopram (Lexapro)
Sertraline (Zoloft)
Therapy
Somatic Symptoms
Headaches Prophylaxis
Propranolol*
Verapamil*
Amitriptyline*
Escitalopram (Lexapro)
Sertraline (Zoloft)
Vestibular Therapy
Cognitive Symptoms
Neurostimulants
Amantadine*
Methylphenidate*
Atomoxetine (Strattera)*
Sleep Disturbance
Melatonin
Trazodone

22. Prevention: EDUCATION! Rule changes necessary to protect the athlete
Teach and coach: head on a swivel, anticipation of a blow
Neck strengthening
Headgear?

23. Neck Strengthening
Video by UWEC

24. Summary The rate of concussions in females is high and on the rise
Consider the possibilities especially in high-risk sports (soccer, lacrosse, basketball, hockey)
Do a thorough assessment
Treat according to cluster of symptoms
Consider prevention parameters
The Athletic Trainer’s role is paramount in the assessment, treatment, and return-to-play decisions

25. Handouts available with resources

26. Thank you Justin Greenwood
Diane Wiese-Bjornstal and the Tucker Institute of Research: University of Minnesota
UWEC ATEP staff
UWEC ATEP students who helped with the video portions of this presentation