When Nancy Burke began her career as an athletic trainer for Virginia’s Fairfax County Public Schools in 1973, the guidelines for head injuries differed drastically from the safety protocols followed today.
“We have known forever that when you get hit on the head, your decision-making is impaired and everything is in confusion,” says Burke, now a consultant for Injury Management for Public Safety.
But four decades ago, the public didn’t know that concussions could have lifelong effects if ignored or treated improperly. A player who took a blow to the head might have been benched for only a matter of minutes before returning to the field.
Today, school administrators allow student-athletes with concussions to take days, weeks or even months to recuperate. In addition, athletic associations have implemented rule changes to lower the likelihood of head trauma, and states have passed legislation to ensure that school officials stick to certain procedures when players experience concussions.
Most significant, the conversation about concussions has moved beyond football. Players of sports such as soccer, volleyball, lacrosse and water polo are also vulnerable to head trauma. And concussions don’t discriminate along gender lines. Both boys and girls are at risk.
However, growing awareness about traumatic brain injuries means that student-athletes are likely safer than ever.
Girls at higher risk of concussions in high school sports?
How common concussions are for high school athletes is unclear, as many still go undiagnosed or unreported. The Centers for Disease Control and Prevention estimates that in 2017, 15% of all student-athletes experienced concussions.
One analysis of 12 years of national data on head injuries uncovered a surprising finding: Female soccer players are more likely to suffer from concussions than players of other high school sports. One in 6.2 girls playing high school soccer during the 2016-17 school year got concussions, according to research by Dr. Wellington Hsu, a professor of orthopedic and neurological surgery at Northwestern University in Illinois.
Compare this to boys soccer in which 1 in 17.2 players had concussions, or to boys football in which 1 in 8.8 players suffered concussions.
Hsu says that poor technique clearly contributes to concussions in soccer.
“There’s also no [or minimal] protective gear in the sport,” Hsu adds. “I think all of those matter in most of the concussions that occur.”
Read more: Water polo now linked to concussions
Joe Schwartzman, the athletic director at Kennebunk High School in Maine, has seen this play out. He has three soccer-playing daughters who have sustained head injuries over the years.
“My oldest played goalie; she got kicked in the head,” Schwartzman says. “My second daughter got hit from behind in seventh grade and then again [had a concussion] in ninth grade.”
Schwartzman partly attributes concussions to strength and conditioning, particularly in girls, whose necks might not be as strong as boys’ necks. Concussions can also be caused by unskilled players—who might have less control over their bodies—colliding with other athletes.
To protect themselves, Kennebunk students learn agility training and safe heading techniques, and are taught to avoid reckless plays. As students develop as competitors, concussions occur less frequently.
Hsu’s examination of concussion data led U.S. Soccer to prohibit players younger than 12 from heading the ball to prevent long-term effects on brain health.
Hsu says unpublished data reveals that concussions in volleyball are also fairly common. Players experience head injuries when they’re hit with balls or they collide with other players, the net pole or the court floor.
In girls lacrosse, moves to make helmets mandatory have sparked debate, with some arguing that head protection makes players feel more secure and results in more aggressive play and an increase in injuries. A recent study from the American Orthopaedic Society for Sports Medicine, however, suggests that headgear in girls lacrosse can reduce injuries and concussions.
Immediate screening
When players experience head injuries today, officials perform in-game assessments such as VOMS (vestibular ocular motor screening), which was developed by Pittsburgh-based health care provider UPMC, to immediately identify concussions. With a reported 90% accuracy rate, the screening examines eyesight, balance and movement.
“I hold up two fingers; I have them focus on something and then balance,” explains athletic trainer Arlene Verre.
Screening marks a shift from Verre’s early days as a trainer. At the start of her career 25 years ago, concussion misconceptions abounded, she says.
“It wasn’t really considered a concussion unless there was amnesia or loss of consciousness,” she says. “But that doesn’t always happen with concussions.”
The standard of care for athletes improved in the early 2000s when research about medical conditions related to head injuries, particularly the degenerative brain disease CTE (chronic traumatic encephalopathy), garnered widespread media attention. Most of the news stories about CTE focused on professional football, but concerns were raised about the effects of head trauma in young athletes.
In 2009, Washington became the first state to pass a law concerning concussion management in youth sports, which required student-athletes with head injuries to be removed from play and to receive medical clearance before returning to compete. Today, all 50 states and the District of Columbia have implemented return to play legislation.
Also in 2009, the Maine Concussion Management Initiative (MCMI) at Colby College formed to better educate coaches, parents and school administrators about head injuries. The group developed a head injury tracker tool in 2013 that allows school trainers and officials to report concussion data. The data helps researchers understand the circumstances in which concussions occur.
Read more: The dangers of repetitive brain trauma
Initially, MCMI provided the tracker to 30 Maine high schools and each member of the New England Small College Athletic Conference. By 2015, all Maine high schools could access the tool, which expanded to Massachusetts high schools the following year.
“We’ve educated parents, teachers, administrators, school nurses and all the doctors in our community [about concussions],” Verre says. “We still don’t have great tools to diagnose concussions, but we have better tools.”
‘We can do more’
It’s impossible to remove concussion risks from sports altogether, but the debate about traumatic brain injuries has led to fewer student injuries, says Hsu, of Northwestern.
“I think what we have now is a pretty good baseline,” he says. “Rule changes, awareness of concussion symptoms and player awareness on the field have all helped. We’ve come a long way. We’re a lot better off in 2019, but we can do more.”
