Girl athletes at risk for concussions as 'culture of resistance' keeps rates high


When it comes to concussions, cheerleading on the sidelines of a high school football game might be getting nearly as dangerous as taking the field with the team — and for young people in all sports, the risks are rising.

Concussions in youth sports overall spiked 66 percent from 2001 to 2009— with young women especially at risk — and the only way to stop the damage is to break through a 'culture of resistance' from parents, coaches and young players, a comprehensive new study suggests.

Despite widespread coverage, damage from concussions is underestimated and blows to the head suffered by young athletes often go unreported, according to a report from the Institute of Medicine released on Wednesday. In addition, football helmets fail to protect against concussions, the report found, although the committee, a group of pediatricians, educators, psychiatrists and engineers, recommended protective gear to prevent other injuries. 

The number of athletes aged 19 and younger who were treated for concussions and other sports and recreation-related traumatic brain injuries rose from 150,000 in 2001 to a quarter million in 2009, the most recent year for which data is available. In college athletics, the rate of concussions in more than a dozen sports doubled between the school year that ended in 1989 and the one that ended in 2004.

Members of Pop Warner youth football teams compete in an exhibition match at halftime of the San Diego Chargers NFL preseason football game against th...
Members of Pop Warner youth football teams compete in an exhibition game in 2009 at halftime of a San Diego Chargers NFL preseason football game. Paul Spinelli

The committee also found that young women and girls have a higher rate of concussions than boys in the sports they both play, including soccer and basketball. And although the rate of concussions in cheerleading remain low compared to other sports, the rate of concussions in the sport increased at a rate of 26 percent each year from 1998 to 2008. That marks a greater rate of increase than for any other sport played by young women at the high school and college levels.

While improved diagnosis may account for at least some of the higher concussion rates "there is probably also a difference in the competitiveness in children and their sports,” said committee member Mayumi Prins, an associate professor in neurosurgery at the UCLA. “Children are being trained earlier in sports and they’re focusing on a single sport rather than diversifying. In the female population we do see that the way girls play sports has changed in the last 10 years — they’re more aggressive.”

Without early diagnosis and proper treatment, teens and young kids are at greater risk of repeated concussions and potential long-term damage. One major factor keeping kids from getting treatment: many think it’s their duty to keep mum about their symptoms,and get back in the game.

“Despite all this new knowledge about concussions and increased awareness in the public, the culture, or behavioral attitudes of our athletes really have not shown the changes that we would expect that would reflect that they are taking concussions seriously,” Prins said. “They still think it’s OK to go back to play with a concussion to help their team. They’ll say, ‘I’m going to underreport so I can get back in.’”

Concussion expert Dr. Robert Cantu says the report brings attention to the growing problem of concussions among children. “Over the last 40 plus years, we’ve taken care of hundreds of youngsters,” said Cantu, a clinical professor of neurology and neurosurgery at the Boston University School of Medicine and co-director of the BU Center for the Study of Chronic Traumatic Encephalopathy.

“We’ve seen cases where the youngster’s trajectory, in terms of intellectual excellence, has been altered by trauma during organized sports. I’m not suggesting that they not play, but the awareness needs to be heightened.”

Helmets for soccer? Some parents say, no thanks
While finding that the jury is still out on the impact of so-called sub concussive, or repeated hits, the committee did find newer brain scanning studies that suggest these hits can add up to brain damage. “Preliminary imaging research suggests that changes in brain white matter may appear after repetitive head impacts; this preliminary finding is supported by the animal literature,” they wrote.

Other findings in the report include:

  • Football, ice hockey, lacrosse, wrestling, and soccer are associated with the highest rates of reported concussions for U.S. male athletes at the high school and college levels.
  • Youths with a history of prior concussion have higher rates of reported sports-related concussions.

The committee called for more research on concussions, particularly on their impact in the youngest athletes, whose brains are especially vulnerable to damage.

“There are a lot of changes happening before someone turns 14,” Cantu said. “And there are a lot of things telling us that the young brain is more vulnerable to trauma than older brains.”