Women and concussions: what do we know? Not nearly enough.

Today we have a co-authored blog by Catherine W and Julia F-C.  Julia F-C is a senior at Stuyvesant High School in New York City. She has a background in Muay Thai and Brazilian Jiu-Jitsu and a passion for feminist theory, sustainability, and plants.

Herewith, our co-authored blog:

Concussions have been in the news lately.  This summer the world of American football was rocked by the release of a study examining 111 brains of deceased NFL (National Football League) players who had conditions including dementia, depression and other behavioral and cognitive disorders.  On autopsy, 110 of the 111 brains were found to have CTE, chronic traumatic encephalopathy.

A recent news story highlighted a study from the same research center that has found that early exposure (before age 12) to football increases the risks twofold or more for cognitive, behavior and affective problems later in life.

 “Hitting your head over and over again in youth seems to lead to later-life problems, even if you only played up through high school or college,” [study author Robert Stern] said.

The research found increased risk was not tied to the number of concussions a player suffered. Translation: Head impacts that aren’t concussions still have serious, long-term effects. That reinforces earlier research.

There’s been pushback from a lot of football stakeholders, including NFL management, fans, and President Donald Trump.

On Friday, Mr. Trump said that the league was losing television viewers in part because it was too focused on safety, including penalizing players for making hard tackles. “They’re ruining the game,” he said.

His comments came a day after scientists announced that Aaron Hernandez, the former Patriots tight end who committed suicide in April, had a severe form of the degenerative brain disease linked to repeated head hits.

Virtually all of the research done on concussions has focused on males, including animal studies.  However, that is changing—research is turning to examining female response to brain injury.

“We classically have always known the male response to brain injury,” says Mark Burns, at Georgetown University. But there have been remarkably few studies of females. The bias runs throughout the scientific literature, even in studies of mice.

“Male mice have been used historically in research and not really been compared to female mice,” he says.

So what have we learned from those female mice?  That there’s a substantive difference in male-vs. female brain response to concussions.  In short, female mice brains respond more slowly and less effectively to brain injury, which may contribute to longer and/or less robust recovery (this last bit is my speculation, but makes sense given the evidence).  The study can be found here.

Studies are now examining humans to look for differences among cohorts of male and female athletes.  Here’s one:

The researchers looked at the medical records of 1,203 athletes who played at Columbia University between 2000 and 2014. (Columbia has collected data about concussion on all its athletes since 2000).

Among male athletes, 17 percent (140/822) had experienced at least one concussion during their collegiate career. Among female athletes, the rate was 23 percent (88/381).

Though women experienced a higher rate of concussion, they recovered and returned to play as quickly as the male athletes.

“Why are women more likely to experience concussion? Is it that they’re physiologically experiencing concussion differently? Are they reporting their concussion in a different manner? This study can’t answer these questions, but it unearths the follow-up questions,” Dr. James Noble says.

Yes—those are some interesting questions, eminently worthy of follow up now.  It’s not a surprise to those of us who follow health research, nor to many of you, our blog readers.

We already know that, for example, women are less likely to be referred for heart-disease-related treatments than men because of the misperception that women are “protected” against cardiovascular disease.  The incidence of heart disease among middle-aged women has increased in the past 20 years, while it has decreased for men of the same age.  You can get all the detail you would ever want from this article.

Back to concussions: this news story discusses a Cleveland Clinic ongoing study of boxers and mixed-martial-arts fighters that includes about 700 men and 60 women.  One of them is MMA fighter Gina “Danger” Mazany.  She describes her first fight below:

“She beat the crap out of me,” Mazany says. “Like she didn’t knock me out, she didn’t finish me. But she just knocked me around for three rounds. And I remember, later that night I was very, very nauseous. I was throwing up that night.”  It was her first concussion.

On the day of Mazany’s annual checkup, she is subjected to a battery of tests that assess her balance, reaction time, memory, and thinking.

After about 40 minutes, Mazany meets with Dr. Charles Bernick, the scientist in charge of the fighters study. They move to a quiet room. Bernick scans a chart. It shows Mazany’s test results over the past few years.

“Well you’re pretty stable,” Bernick says. There’s no obvious sign of trouble from her fighting career, at least not yet.

I talked with some friends who are fighters and coaches for fighting sports about concussions.  Karen Miller Peterson, a black belt in Brazilian Jiu Jitsu, has competed and taught and coached, and recently opened a school called North South BJJ in Montclair, NJ with her husband Adam, also a BJJ fighter and teacher.  Karen’s experience with Brazilian Jiu Jitsu suggests that concussions may depend at least in part on style and training:

I think it’s fighting style. Since there’s no striking in jiu jitsu, it just doesn’t happen a lot. Situations it might happen would be in a takedown or throw, which aren’t practiced in academies as much as ground grappling. You can see it happen in competition from time to time. We do sometimes get knocked in the head during training or in a competition, but rarely is it hard enough to cause a concussion. Maybe a broken nose or bruise. It could happen, sure, but because of the style of jiu jitsu it just doesn’t happen like boxing or MMA.

Skill will definitely play into it too. Head injuries in jiu jitsu will happen more often with lower belts/beginners.

I spoke to Cesar Nicolas, a long-time trainer and coach for multiple sports (boxing, BJJ, kids’ soccer, baseball and wrestling) as well as a brown belt fighter and competitor. His primary concern is that sports may inadvertently conceal risks of head injury.  He cites head gear in boxing and MMA– it may seem as if it’s protecting fighters, but it does not actually end up protecting them from significant blows.  As a soccer coach for middle schoolers, Cesar notes that when someone’s head makes contact with a soccer ball, this can cause serious injury.  In one study, researchers found that 1/3 of all concussions among US male high school players and 1/4 of those among female players involved heading the ball.  However, the study did not look at data on younger children.  Cesar’s observations about soccer are in keeping with concerns about football played by younger children.

So how do concussion worries affect what younger women think and do in sports?  For her viewpoint, we turn to my co-blogger, Julia Farach-Colton for some comments.  Here’s Julia…