Female Concussions (mTBI)

Concussion research has predominately focused on males, specifically male youths and adults playing sports such as hockey, football, rugby and soccer. There was little research on the differences between male and female brain injuries.

That is changing.

I attended the 7th Annual Concussion Research Symposium entitled Advances in Concussion Research, including Concussion in Women and Girls, held November 2, 2019. It was organized by the United Health Network’s Krembil Neuroscience Centre and the Canadian Concussion Centre (Toronto Western Hospital) in Toronto, Ontario, Canada.

A hit to the head or sudden acceleration of the head causes, in sequence:

Mechanical injury to the brain or brain stem as it moves inside the skull.

Chemical injury (inflammation resulting from an influx of Sodium (Na) and Calcium (Ca)).

Electrical grid disruption, effectively shutting down brain circuits and Beta waves (20 Hz).

Post concussion, there are three categories of potential symptoms:

Physical

Mood

Cognitive

WHAT I LEARNED AT THE CONFERENCE

Key takeaways: while fewer females than males (comparing total numbers) suffer concussions, and given females receive equivalent impact forces as those experienced by males:

• Female brain nerve axons suffer more damage. Inflammation caused by the influx of sodium and calcium after brain injury is more severe;

• Females have more complicated and longer lasting post concussive symptoms. Anxiety and depression are common symptoms that make other symptoms worse. Of those with post concussive symptoms, 37% have depression, anxiety or both;

• Stress inhibits recovery. A neuropsychologist told me the analogy she uses with her clients is that stress is like pouring acid in an open wound. Psychological counselling or other ways of reducing stress are vitally important to recovery;

• Ten percent of victims continue to suffer symptoms one year post-concussion;

• A study of adolescents in a private school reported that girls take longer to return to sport than boys (30 days), girls don’t want to be out of school, and they tend to minimize their symptoms in order to return to school and play;

• Adult women with post concussive symptoms are more likely than men to not return to work. They cannot manage their “double shift” household and child-rearing responsibilities and their jobs;

• There are many changes in the brain from subconcussive impacts (such as heading the soccer ball) despite no diagnosed concussion. Females athletes are more sensitive to subconcussive impacts than males in the long term;

• Aerobic exercise within the first two weeks of concussion is helpful to recovery. Physical activity may counterbalance the effects of subconcussive hits. In other words, be active without risking another brain injury.

• Concussion symptoms are invisible. Sufferers do not get the same sympathy as those who suffer from cancer, for example. They may be accused of malingering. The Concussion Awareness Training Tool may be helpful in creating awareness at home, school and work. https://cattonline.com/;

• Individual differences in neurophysiologic susceptibility and recovery are profound. Some athletes have genetically superior repair capabilities. Douglas Smith, MD, of the University of Pennsylvania said, “Elite athletes have the DNA to resist injury and repair from injuries or they wouldn’t get that far.”

AFTER MULTIPLE CONCUSSIONS YOU’D HAVE TO BE CRAZY TO RETURN TO SPORT

Imaging options have evolved, and researchers are developing blood biomarkers to help identify concussion and indicate longer term recovery. Researchers are increasingly able to document brain damage in living brains, rather than only in cadaver brains. However, while localized injury shows up in scans, diffuse axonal injury in the brain’s white matter does not.

Tellingly, there were no conference presentations on evidence-based treatments to reverse brain damage. Once an axon disconnects from the brain’s electrical grid, it will never reconnect. Axonal damage produces a parent protein that contributes to plaques and TBI-related neurodegeneration such as CTE. The damage spreads to remote brain regions.

Key takeaway: the damage due to multiple concussions and subconcussive impacts is irreversible and cumulative.

GIVEN THE RISK, WHY DO MANY RETURN TO SPORT?

Teens and young adults return to sport for these reasons:

• The adolescent brain is poor at anticipating consequences.

• Teens take more risks.

• Peer pressure. Teens are four times more likely to engage in risky behavior if another teen is present.

• They don’t want to let the team/coach/parent down. 80% of males don’t want to be taken out of the game. Anecdotally, many don’t believe concussion is real.

• Social reasons. Teens want to belong. Their identity is tied to the team. This is especially true of females.

What happens to a teen who cannot keep up in school and suffers from concussion-related anger, aggression, mood issues, irritability, thinking problems, and chronic pain? These teens may turn to drugs and crime. In a UK-based study, 3 or 4 in 10 students who suffered mTBI developed a long term problem. 65% of UK youth offenders had suffered head injuries.

Physicians, coaches, and parents need to know that the risk of further damaging a vulnerable brain after a concussion or multiple concussions is very high. A subsequent concussion could result in permanent disability and ruin a teen’s education and career prospects. The onus is on adults to make this risk clear to the teens for whom they are responsible.

PINKCONCUSSIONS.COM

Pink Concussions is a non-profit organization founded by Katherine Price Snedaker of New Jersey, USA.

The website https://www.pinkconcussions.com/offers information, resources and access to research on female mTBI. Concussion sufferers and practitioners can sign up with various online support groups, including Pink Canada for Canadians.

This organization is run by volunteers. All donations support endeavors to support females who have suffered head injuries, including women in the military and abused women.

Read more about female brain injury at https://www.pinkconcussions.com/brain-injury .

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Madeline McBride, M.A.Sc., P.Eng., is a Neuromuscular Therapist and Certified Bowenwork Practitioner specializing in concussion, whiplash, myoskeletal alignment and hormone balancing. Subscribe to her blog at https://www.mcbridepainclinic.com/blog .