Transcript Concussions in the Female Athlete - WATA Inc.

Jeanne Brown, MS, ATC-L
OakLeaf Concussion Clinic
Eau Claire, WI
2012- Marar M, Comstock RD – Am J Sports Med
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Fewer overall than males, but increasing over
time
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Games riskier than practices
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Higher rates for females in comparable sports
and greater percent of total injuries
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Much sex similarity, and modest sex difference
shown so far in risks, symptoms and effects
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Anatomy
-Smaller head than male counterpart
-Weaker neck muscles, less neck mass
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Females have a higher incidence of headache and/or
migraine making them more susceptible to concussion
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Style of play:
- Not anticipating blows
- Head not on a swivel
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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
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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).
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are females just better reporters?
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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
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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
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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
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Complete History / Mechanism of Injury
Balance Testing
CGS (alone with the athlete/no parent)
Neuro-psych testing
VOR testing
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Symptoms for females tend to be
neurobehavioral and somatic in nature
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Females report more symptoms than males
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Females have greater sensitivity to subtle
symptoms
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Females report more drowsiness and fatigue
•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
Neuropsychiatric
- More emotional
-Sadness
-Nervousness
-Irritability
Migraine (Physical SX)
-Headaches
-Visual Problems
-Dizziness
-Noise/Light sensitivity
-Nausea
Cognitive Symptoms
-Attention Problems
-Memory dysfunction
-”Fogginess”
-Fatigue
-Cognitive slowing
Sleep Disturbance
-Difficulty falling asleep
-Sleeping less than usual
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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
Emotionality
•SSRIs
•Escitalopram (Lexapro)
•Sertraline (Zoloft)
•Therapy
Somatic Symptoms
• Headaches Prophylaxis
Cognitive Symptoms
•Neurostimulants
•Propranolol*
•Verapamil*
•Amitriptyline*
•Escitalopram (Lexapro)
•Sertraline (Zoloft)
•Amantadine*
•Methylphenidate*
•Atomoxetine (Strattera)*
• Vestibular Therapy
Sleep Disturbance
• Melatonin
•Trazodone
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EDUCATION!
Rule changes necessary to protect the athlete
Teach and coach: head on a swivel, anticipation
of a blow
Neck strengthening
Headgear?
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Video by UWEC
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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
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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