Concussion

photo Suzy Allman/NY Times

Not Glamorous, Not Cool

From the Group News Blog Sports Desk, this is Jesse Wendel with a Special Report on Women, Health and Sports.

My oldest daughter, Avian (now 20) was an all-star defensive soccer player.

She started playing on rec teams very young, then moved to club soccer at 12 and played all the way through high school. At 17 the club team she was on won all-state in her division (one down from the most senior division.) At 18 she went to community college and was selected to the all-star team for the western half of Washington State for the league in which Community Colleges play. She was a joy to watch on the field, fluid, graceful, fearless, fast, and more than a little dangerous.

She also got hurt, and she hurt others.

The motto by which Avian played was, "Dad, if I knock someone unconscious in the first five minutes, they'll fear me the rest of the game." She said it in jest, but she played it for real.

Avian knocked people out. She didn't play dirty. Her tackles were always clean. She didn't get red-carded. She didn't even get yellow carded. She waited for the moment she could throw an absolutely clean tackle directly in front of the referee -- that would leave the other team's best striker stunned or unconscious on the grass. Ideally within minutes of the games' start.

Nothing personal. Avian simply believed to her emotional core opposing strikers should fear her. And they did.

New York Times

Hannah Stohler sat beside the piano she could no longer play, in the living room that spun like a carousel, in the chair in which she tried to read but could not remember a word. Ten months after her third concussion while playing high school soccer knocked her into a winter-long haze of headaches and dizziness and depression that few around her could comprehend, Stohler recalled how she once viewed concussions.

“I thought they were a football injury — a boy thing,” said Stohler, a junior at Conard High School in West Hartford, Conn. “Those guys are taught to hit hard and knock people to the ground. But anyone can get a concussion, and I don’t think a lot of girls recognize that. They have no idea how awful the effects can be — it changes your life.”

Stohler, 16, has more company than most people know. While football does have the most concussions (and controversy over their treatment) in high school athletics, girls competing in sports like soccer and basketball are more susceptible to concussions than boys are in the same sports, studies show.

According to a study to be published in the Journal of Athletic Training, in high school soccer, girls sustained concussions 68 percent more often than boys did. Female concussion rates in high school basketball were almost three times higher than among boys.

Girls also consistently took longer for their symptoms to resolve and to return to play. The study, conducted by researchers at Ohio State University and Nationwide Children’s Hospital, examined data submitted by 425 certified athletic trainers across the United States during the 2005-6 academic year. According to the National Federation of High School Sports Associations, a million youngsters play high school basketball and 700,000 play high school soccer each year; male participation is only slightly higher than among girls.

“Generally speaking, the medical profession does not do a very good job in recognizing that female athletes sustain concussions at an equal or even higher rate as males,” said Dr. Robert Cantu of Brigham and Women’s Hospital in Boston, one of the nation’s leading experts in concussion management. “It’s flying under the radar. And as a result, looking for concussions in women is not pursued with the same diligence, and it’s setting girls up for a worse result.”

Hannah Stohler twice slammed her head against the turf while playing soccer last fall, both times experiencing the disorientation, blurred vision and nausea that are telltale signs of concussion. She said her neurologist at the time told her that when her headaches subsided, she could play again.

“I really didn’t think it was a big deal,” she recalled, adding that she returned a few weeks later before her other symptoms had cleared. “Soccer is everything to me. I identify myself as an athlete.”

In November, Stohler collided with another player, could not get up for 10 minutes, and left the field with her vision totally black. Her eyesight returned, but she experienced headaches and disorientation for three months, could barely read and was forbidden to exercise for fear of causing further damage.

“I was the freak at school who could only do half days and had to go home all the time,” said Stohler, whose reading comprehension and memory remain slightly impaired. “I didn’t feel like myself — ever. I was miserable. It takes the life out of you.”

According to the study to be published in the Journal of Athletic Training, football has the highest rate of concussions in high school sports, with 47 such injuries per 100,000 player games or practices. Girls soccer was second highest with 36 per 100,000, followed by boys soccer (22) and girls basketball (21).

“Girls are just as competitive as boys, and they’ll push through concussions just like boys would,” [basketball player] Ingles said. “For every one of me, who ends up getting treated, there are maybe four or five who keep playing because they don’t want to admit they’re hurt. It’s easier not to do anything. It’s really going to mess them up further.”

Avian was knocked out herself three times, each time just yards in front of me.

I remember once she was out for only five seconds. Just shook it off and kept playing. But after the game, she didn't know where she was, didn't even remember the game.

Concussion.

Our family doctor, certified in both family practice and sports medicine is also the team doctor for the Seattle Seahawks. Dr. Brad Shoup grounded Avian for over a week.

Another time she was down on the field for a solid minute. That time I just took her straight to the E.R. She wasn't the only one of the girls on the team I remember ordering to the E.R. and sitting with while they were groggy.

The pressure from the children -- because that's what they are; young ladies with emotions, wanting desperately to fit in with their friends, competitive as hell, and this, soccer, is who they know them self as. When you take the game away you're telling them they're failing as a person, not good enough -- is relentless. Avian and the other youngsters we benched never ever stopped demanding to play.

The coaches just want to win. Their continued employment depends on winning. There isn't a line in the box scores called: "Concussions." Or "Girls Healing." There's just "Won:Lost:Tied." And it's all anyone looks at. Getting a star striker, mid-fielder or defender back on the pitch matters. And fuck their health.

With Avian's final concussion, minor, but her third in several years, she was being trained at arguably Puget Sound's most prestigious training facility. The concussion happened on game day elsewhere. Two days later back in training, her trainer -- a former World Cup & Olympic gold medalist, would have nothing to do with letting Avian play. Trainers understand injury and precisely because their salary is spread out over twenty teams, may do the right thing. In Avian's case at least I had one person on the side of sanity and her health. But her two coaches wanted her playing. Her team wanted her playing. And Avian was determined to play and to hell with Dr. Shoup.

I issued written instructions to both coaches, copy to Avian, that she was not to play till either I or Dr. Shoup gave written permission otherwise, then walked away, with Avian screaming how she hated me forever. That was three years ago.

A week or two later she finally was allowed back on the pitch -- after Dr. Shoup gave permission.

In the years to come Avian and the teams she was on took all-state, and she was selected to the all-star team for Western Washington as a freshman defender playing at the Community College level.

Then she moved on.

Today Avian doesn't play soccer. She's a hairdresser and a good one. Self identities change. The need to be healthy remains. Avian and I haven't talked for several months since she blew out of here one day in a huff, leaving her room a mess like I was her damn landlord. Her sisters tell me she's doing alright on her own.

At least she has her health.

This has been a Special Report on Women, Health and Sports from the Group News Blog Sports Desk, Jesse Wendel reporting.