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Girls often continue playing soccer with concussion symptoms

By Shereen Jegtvig

NEW YORK (Reuters Health) - Young female soccer players may get more concussions than their high school and college counterparts, and many of them continue to play while they have symptoms, according to a new study.

Concussions can result in memory loss and problems with concentration and reaction time. The effects are worse when an athlete suffers a second concussion before fully recovering from the first.

U.S. high school soccer players get about 50,000 concussions each year, but no one's been keeping track of concussions among younger girls, researchers said.

They found 13 percent of those athletes suffered a concussion each season, and more than half kept playing after the injury.

"We were surprised at the number of girls reporting symptoms but more surprised at the number that played despite symptoms and never saw a health professional for their symptoms," Dr. John O'Kane told Reuters Health in an email.

O'Kane led the study at the University of Washington's Department of Orthopaedics and Sports Medicine in Seattle.

"Kids should understand that these symptoms could indicate a potentially serious injury and that they must stop play when they occur and notify their parents," he said.

O'Kane and his colleagues studied 351 girls ages 11 to 14 from 33 soccer teams in the Puget Sound area of Washington. They followed each team for at least one season over a total of four years.

The researchers sent weekly emails to parents asking if the girls had suffered any hits to the head that resulted in symptoms usually associated with concussions. Those include memory loss, difficulty concentrating, confusion, dizziness, headaches, ringing in the ears and sensitivity to light or sound.

If they responded with a yes, players were contacted by members of the study team and asked more detailed questions, including if they had been to the doctor and whether they continued to play with symptoms.

There were 59 concussions during the study, including eight repeat concussions. Most occurred during games either as a result of hitting another player or when heading the ball.

The rate of 1.3 concussions for every 1,000 hours of practice or game time was higher than what has been reported in studies of female soccer players at the high school and college levels.

Symptoms lasted an average of nine days, and less than half of concussed girls sought medical attention. More than 58 percent continued to play with their symptoms, the researchers reported in JAMA Pediatrics.

O'Kane said parents of athletes in any contact or collision sport should be aware of the symptoms of concussion and share that knowledge with their kids. He said it's the parent's responsibility to ensure that kids with concussion symptoms are appropriately evaluated before returning to play.

"If you've had a concussion, and then you get a second while you still haven't recovered from the first, your symptoms are much worse and they last for much longer," Dr. Amanda Weiss-Kelly told Reuters Health.

Weiss-Kelly is division chief of pediatric sports medicine at University Hospitals Rainbow Babies and Children's Hospital of Case Western Reserve University in Cleveland, Ohio. She wasn't involved in the new study.

"We have realized there's more going on with concussions than what we previously thought," she said.

Weiss-Kelly explained that subtle but serious symptoms might continue for up to two weeks after the initial injury. Memory loss and problems with concentration may affect kids and how well they perform in school.

Many concussions happened while the players were heading the ball - possibly because they hadn't progressed far enough to be able to perform the maneuver safely.

"It certainly begs the question, ‘Should we put off heading the ball especially in game situations until we think kids are older and more coordinated and more capable of doing it in an appropriate fashion?'" Weiss-Kelly said.

She was concerned the general public may start to feel inundated with concussion education at this point.

"A lot of people think we're swinging too far on the caution side and I would argue that with kids that's impossible. You can't be too careful with kids' brains," she said.

"The fact that so few of these kids sought medical attention proves we haven't done enough."

SOURCE: http://bit.ly/1adWrco JAMA Pediatrics, online January 20, 2014.

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