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Walshe A, Daly E, Ryan L. Epidemiology of sport-related concussion rates in female contact/collision sport: a systematic review. BMJ Open Sport Exerc Med 2022; 8:e001346. [PMID: 36157128 PMCID: PMC9490625 DOI: 10.1136/bmjsem-2022-001346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2022] [Indexed: 11/04/2022] Open
Abstract
Objectives To determine sport-related concussion (SRC) incidence rates in female contact/collision sport. Design Systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Data sources Four databases (PubMed, SportsDiscus, Web of Science, CINAHL) were searched for data from 2012 to 2021. Eligibility criteria Studies reporting SRC incidence rates or the number of concussions and athletic exposures (AEs) per 1000 participating events or hours in healthy female contact and collision sport athletes of any age were included. Results The search yielded 8438 non-duplicate articles. Following screening, 19 were included in the analysis (median quality score=70%), with 8 reporting match or training incidence rates. Studies were primarily from US high school and collegiate populations; data are reported for eight sports. Rugby union reported the highest match SRC rates (8.2-16.11 per 1000 AE hours), followed by Gaelic football (5.21 per 1000 AE hours) and soccer (2.08-4.04 per 1000 AE events). Where available, match SRC rates were substantially higher than training and overall SRC rates. Conclusion Female sports such as rugby union, Gaelic football and soccer present the highest risk for SRCs within the available data. Previous research indicates a potentially greater injury burden for female athletes experiencing SRCs than their male counterparts. Thus, future research should analyse concussion knowledge and return-to-play protocols in these sports. Future research should also prioritise exploration of the gap in SRC rates within amateur sports, and data should be presented specifically in the context of athletic exposures (match vs training). Trial registration number CRD42021281569.
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Affiliation(s)
- Ayrton Walshe
- Sport, Exercise and Nutrition, Atlantic Technological University, Galway, Ireland
| | - Ed Daly
- Sport, Exercise and Nutrition, Atlantic Technological University, Galway, Ireland
| | - Lisa Ryan
- Sport, Exercise and Nutrition, Atlantic Technological University, Galway, Ireland
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2
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Lota KS, Malliaropoulos N, Blach W, Kamitani T, Ikumi A, Korakakis V, Maffulli N. Rotational head acceleration and traumatic brain injury in combat sports: a systematic review. Br Med Bull 2022; 141:33-46. [PMID: 35107134 PMCID: PMC9351374 DOI: 10.1093/bmb/ldac002] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/04/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) in combat sports is relatively common, and rotational acceleration (RA) is a strong biomechanical predictor of TBI. This review summarizes RA values generated from head impacts in combat sport and puts them in the context of present evidence regarding TBI thresholds. SOURCES OF DATA PubMed, EMBASE, Web of Science, Cochrane Library and Scopus were searched from inception to 31st December 2021. Twenty-two studies presenting RA data from head impacts across boxing, taekwondo, judo, wrestling and MMA were included. The AXIS tool was used to assess the quality of studies. AREAS OF AGREEMENT RA was greater following direct head strikes compared to being thrown or taken down. RA from throws and takedowns was mostly below reported injury thresholds. Injury thresholds must not be used in the absence of clinical assessment when TBI is suspected. Athletes displaying signs or symptoms of TBI must be removed from play and medically evaluated immediately. AREAS OF CONTROVERSY Methodological heterogeneity made it difficult to develop sport-specific conclusions. The role of headgear in certain striking sports remains contentious. GROWING POINTS RA can be used to suggest and assess the effect of safety changes in combat sports. Gradual loading of training activities based on RA may be considered when planning sessions. Governing bodies must continue to work to minimize RA generated from head impacts. AREAS TIMELY FOR DEVELOPING RESEARCH Prospective research collecting real-time RA data is required to further understanding of TBI in combat sports.
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Affiliation(s)
- Kabir Singh Lota
- Barts and The London School of Medicine and Dentistry, London, E1 2AD, UK.,Centre for Sports and Exercise Medicine, Queen Mary University of London, E1 4DG, UK
| | - Nikos Malliaropoulos
- Centre for Sports and Exercise Medicine, Queen Mary University of London, E1 4DG, UK.,Sports and Exercise Medicine Clinic, Asklipiou 17, 54639 Thessaloniki, Greece.,Rheumatology Department, Sports Clinic, Barts Health NHS Trust, London, E1 4DG, UK
| | - Wiesław Blach
- Department of Physical Education and Sport, University School of Physical Education, Wrocław 51-612, Poland
| | - Takeshi Kamitani
- School of Sport and Health Science, Tokai Gakuen University, 21-233 Nishinohora, Ukigai, Miyoshi, Aichi, 470-0207, Japan
| | - Akira Ikumi
- Department of Orthopedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Clinical Education and Training Center, 3-2-7 Miyamachi, Mito, Ibaraki 310-0015, Japan
| | | | - Nicola Maffulli
- Centre for Sports and Exercise Medicine, Queen Mary University of London, E1 4DG, UK.,Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, Baronissi, Salerno 84081, Italy.,School of Pharmacy and Bioengineering, Faculty of Medicine, Keele University, Stoke-on-Trent, ST4 7QB, UK
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3
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Dave U, Kinderknecht J, Cheng J, Santiago K, Jivanelli B, Ling DI. Systematic review and meta-analysis of sex-based differences for concussion incidence in soccer. PHYSICIAN SPORTSMED 2022; 50:11-19. [PMID: 33357128 DOI: 10.1080/00913847.2020.1868955] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To compare concussion incidence in male and female soccer players due to the specific concussion-causing activity. METHODS/DATA SOURCES PubMed, EMBASE, and Cochrane Library were searched for studies published between January 2000 and February 2020. Search terms included 'sex,' 'gender,' 'sex differences,' 'brain injury,' 'sports,' 'athletes,' 'incidence,' 'epidemiology,' 'symptoms,' and 'injury rate.' Studies that contained data on concussion incidence in soccer and featured comparisons by sex and soccer activity were included. Studies that were not written in English, contained data on non-sports-related concussions, or were conference abstracts were excluded. RESULTS Six studies were included in this meta-analysis, each of which contributed the number of concussions in males and females for a specific soccer activity. Concussion incidence rates were calculated using athlete-exposures as the denominator and a rate ratio was measured by dividing the concussion rate among female soccer players by the rate among male soccer players. Female soccer players were shown to have a greater rate of concussions from heading [1.65 (95% CI: 1.35, 2.03, p < 0.001)] and goalkeeping [1.63 (95% CI: 1.22, 2.17, p = 0.001)]. There were 3 studies comparing sex differences for general play. While the pooled rate ratio was statistically significant [1.51 (95% CI: 1.12, 2.04), p = 0.007], this result was largely driven by 1 study. CONCLUSION Concussion incidence rates were significantly higher in female soccer players compared to male players while heading. There is also some evidence to suggest that the incidence is higher for female goalkeepers. Soccer coaches and health care providers need to recognize this sex difference when coaching or treating players.
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Affiliation(s)
- Udit Dave
- Department of Biology, Georgetown University, Washington, D.C., U.S.A
| | - James Kinderknecht
- Sports Medicine Institute, Hospital for Special Surgery, New York, N.Y., U.S.A
| | - Jennifer Cheng
- Department of Physiatry, Hospital for Special Surgery, New York, N.Y., U.S.A
| | - Kristen Santiago
- Department of Physiatry, Hospital for Special Surgery, New York, N.Y., U.S.A
| | - Bridget Jivanelli
- Kim Barrett Memorial Library, Hospital for Special Surgery, New York, N.Y., U.S.A
| | - Daphne I Ling
- Sports Medicine Institute, Hospital for Special Surgery, New York, N.Y., U.S.A.,Department of Population Health Sciences, Weill Cornell Medical College, New York, N.Y., U.S.A
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4
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Kaminski TW, Chrisman SPD, Glutting J, Wahlquist V, Eagle S, Putukian M, Tierney R, Broglio SP, McAllister TW, McCrea MA, Pasquina PF, Kontos AP, Investigators CARES. Mechanisms of injury for concussions in collegiate soccer: an NCAA/DoD CARE consortium study. SCI MED FOOTBALL 2021; 6:325-330. [DOI: 10.1080/24733938.2021.1991586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Thomas W. Kaminski
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA
| | - Sara P. D. Chrisman
- Center for Child Health, Behavior and Development, Seattle Children’s Hospital, Seattle, WA, USA
| | - Joseph Glutting
- School of Education, University of Delaware, Ne’wark, DE, USA
| | - Victoria Wahlquist
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA
| | - Shawn Eagle
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Margot Putukian
- Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
| | - Ryan Tierney
- Department of Health and Rehabilitation Sciences, Temple University, Philadelphia, PA, USA
| | - Steven P. Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, MI, USA
| | - Thomas W. McAllister
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Michael A. McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Paul F. Pasquina
- Physical Medicine and Rehabilitation, Uniformed Services University, Bethesda, MD, USA
| | - Anthony P. Kontos
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
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5
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Blyth RJ, Alcock M, Tumilty DS. Why are female soccer players experiencing a concussion more often than their male counterparts? A scoping review. Phys Ther Sport 2021; 52:54-68. [PMID: 34419893 DOI: 10.1016/j.ptsp.2021.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 07/30/2021] [Accepted: 08/01/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND The risk of concussion is particularly high in female soccer players. There is no consensus as to why female soccer players are at an elevated risk. OBJECTIVE To synthesise current evidence investigating reasons for the increased concussion rate in female soccer players. SOURCES Searching of six databases (MEDLINE, Scopus, CINAHL, SportDiscus, Web of Science and the Cochrane Library) and grey literature was performed between 13/07/2020-31/07/2020. Keywords were concussion-related terms, terms relating to female football/soccer and terms relating to the mechanism/cause. No constraints were placed on publication date and quantitative or exploratory studies meeting inclusion criteria were eligible. Exclusion criteria were studies not published in English and qualitative studies. RESULTS Several hypotheses were identified to explain increased concussion rates in female soccer players, these include, reduced neck strength/anthropometrics, increased head acceleration, increased ball-to-head concussions, differences in hormones and brain structure/function, and reduced visual awareness. CONCLUSION Promising ideas/reasons have been identified for increased concussion rates in female soccer players. Despite hypothesis generation there is scarce high-level evidence which is required to guide injury prevention and/or rule changes to protect female soccer players. The level of evidence for included studies is level 2-3 with most being observational cross-sectional or cohort studies.
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Affiliation(s)
- Rebecca Jane Blyth
- School of Physiotherapy, University of Otago, 325 Great King Street, North Dunedin, Dunedin, 9016, New Zealand.
| | - Mark Alcock
- School of Physiotherapy, University of Otago, 325 Great King Street, North Dunedin, Dunedin, 9016, New Zealand
| | - Dr Steve Tumilty
- School of Physiotherapy, University of Otago, 325 Great King Street, North Dunedin, Dunedin, 9016, New Zealand
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6
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Bretzin AC, Covassin T, Wiebe DJ, Stewart W. Association of Sex With Adolescent Soccer Concussion Incidence and Characteristics. JAMA Netw Open 2021; 4:e218191. [PMID: 33904911 PMCID: PMC8080231 DOI: 10.1001/jamanetworkopen.2021.8191] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/10/2021] [Indexed: 01/02/2023] Open
Abstract
Importance Because of the negative consequences of concussion, considerable research efforts have been directed toward understanding the risk factors for sport-related concussion (SRC) and its outcomes to better inform strategies for risk reduction. Girls are suggested to have an increased risk of concussion, warranting exploration into sex-dependent variations in concussion presentation and management, with the potential that this information might inform sex-specific rules directed toward risk reduction within sports. Objective To compare sex-associated differences in epidemiology and concussion management in adolescent soccer players within a prospective, longitudinal high school injury surveillance project. Design, Setting, and Participants This prospective, longitudinal cohort study assessed male and female soccer athletes from all high schools in the Michigan High School Athletic Association (MHSAA) during academic years 2016-2017 to 2018-2019. Exposures Sport-related concussion captured in the MHSAA Head Injury Reporting System. Main Outcomes and Measures Outcomes included details regarding each documented SRC event, including injury mechanism, immediate management, and return-to-play time. Multiple comparisons were made between male and female athletes regarding SRC risk, mechanism, short-term management, and outcomes. Results A total of 43 741 male and 39 637 female soccer athletes participated in MHSAA soccer during the 3 consecutive academic years of study (2016-2017: n = 751 schools; 2017-2018: n = 750 schools; and 2018-2019: n = 747 schools). During the 3 years of surveillance, 1507 of the 83 378 soccer athletes (1.8%) were reported to have SRC during soccer participation, including 557 boys (37.0%) and 950 girls (63.0%). Documented SRC risk in female soccer participants was greater than in male soccer participants (risk ratio, 1.88; 95% CI, 1.69-2.09; P < .001). Male soccer athletes most often sustained SRC from contact with another player (48.4%), whereas SRCs in female soccer players recorded in the Head Injury Reporting System were most often from nonplayer contact events (41.9%; P < .001). Adolescent male soccer players with a documented SRC were more likely to be removed from play on the day of injury (odds ratio, 1.54; 95% CI, 1.15-2.06; P = .004). Although the overall median time to return to play was 11 days (interquartile range [IQR], 7-15 days), male athletes typically returned 2 days earlier than female athletes (median, 10 [IQR, 7-14] days vs 12 [IQR, 7-16] days; Peto test P < .001). Conclusions and Relevance In this cohort study, sex-associated differences were revealed among adolescent soccer athletes in SRC risk, mechanism of injury, immediate management, and outcomes in injuries documented in a statewide injury reporting system. Thus, consideration might be given to sex-specific approaches to participation and concussion management in the sport.
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Affiliation(s)
- Abigail C. Bretzin
- Penn Injury Science Center, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Tracey Covassin
- Department of Kinesiology, Michigan State University, East Lansing
| | - Douglas J. Wiebe
- Penn Injury Science Center, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - William Stewart
- Department of Neuropathology, Queen Elizabeth University Hospital, Glasgow, United Kingdom
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, United Kingdom
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Beaudouin F, Gioftsidou A, Larsen MN, Lemmink K, Drust B, Modena R, Espinola JR, Meiu M, Vouillamoz M, Meyer T. The UEFA Heading Study: Heading incidence in children's and youth' football (soccer) in eight European countries. Scand J Med Sci Sports 2020; 30:1506-1517. [PMID: 32335945 DOI: 10.1111/sms.13694] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 04/15/2020] [Accepted: 04/20/2020] [Indexed: 12/28/2022]
Abstract
To assess the real-life magnitude of the heading incidence in children's and youth' football in eight European countries with different "football cultures," a cross-sectional observational design, in which one match per team in 480 different teams from eight European countries (2017/18-2018/19), was recorded by video. One training session was recorded in 312 teams. Clubs with Under-10, Under-12 (female/male/mixed), and Under-16 female and male teams were eligible to participate. Heading frequencies and types were analyzed. Results are presented as headers per match/training and per team. Incidence rates (IR) per 1000 match/training hours were calculated. Under-10 teams carried out the lowest average number of headers per match (8.8), followed by Under-16 female (17.7), Under-12 (18.4), and Under-16 male (35.5). Total number of headers per match and team varied between countries. 80% of the total number of headers were single intentional headers, 12% heading duels, 3% unintentional headers by getting hit, and 5% others (trends apparent in all age groups). Three head injuries occurred during match play corresponding to an IR of 0.70 (95% CI, 0.23-2.16). The lowest number of headers per training and team was found in Under-10 (21.3), followed by Under-16 females (34.1), Under-12 (35.8), and Under-16 males (45.0). In conclusion, this large-scale study presents novel data about the number and type of headers in youth' football throughout Europe. A more precise understanding of the heading incidence, specifically in young players, is mandatory for the debate of restrictions on heading in youth football.
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Affiliation(s)
- Florian Beaudouin
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany
| | - Asimenia Gioftsidou
- Department of Physical Education and Sport Sciences, Democritus University of Thrace, Komotini, Greece
| | - Malte Nejst Larsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Koen Lemmink
- Center of Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Barry Drust
- Sport and Exercise Sciences, John Moores University, Liverpool, UK
| | - Roberto Modena
- CeRiSM Research Center Sport Mountain and Health, University of Verona, Verona, Italy
| | | | - Mihai Meiu
- Romanian Football Federation, Bucharest, Romania
| | - Marc Vouillamoz
- Union des Associations Européennes de Football (UEFA), Nyon, Switzerland
| | - Tim Meyer
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany
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Caccese JB, Santos FV, Yamaguchi F, Jeka JJ. Age of First Exposure to Soccer Heading and Sensory Reweighting for Upright Stance. Int J Sports Med 2020; 41:616-627. [PMID: 32365387 DOI: 10.1055/a-1141-3553] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
US Soccer eliminated soccer heading for youth players ages 10 years and younger and limited soccer heading for children ages 11-13 years. Limited empirical evidence associates soccer heading during early adolescence with medium-to-long-term behavioral deficits. The purpose of this study was to compare sensory reweighting for upright stance between college-aged soccer players who began soccer heading ages 10 years and younger (AFE ≤ 10) and those who began soccer heading after age 10 (AFE > 10). Thirty soccer players self-reported age of first exposure (AFE) to soccer heading. Sensory reweighting was compared between AFE ≤ 10 and AFE > 10. To evaluate sensory reweighting, we simultaneously perturbed upright stance with visual, vestibular, and proprioceptive stimulation. The visual stimulus was presented at two different amplitudes to measure the change in gain to vision, an intra-modal effect; and change in gain to galvanic vestibular stimulus (GVS) and vibration, both inter-modal effects. There were no differences in gain to vision (p=0.857, η2=0.001), GVS (p=0.971, η2=0.000), or vibration (p=0.974, η2=0.000) between groups. There were no differences in sensory reweighting for upright stance between AFE ≤ 10 and AFE > 10, suggesting that soccer heading during early adolescence is not associated with balance deficits in college-aged soccer players, notwithstanding potential deficits in other markers of neurological function.
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Affiliation(s)
- Jaclyn B Caccese
- School of Health and Rehabilitation Sciences, Ohio State University College of Medicine, Columbus, United States
| | | | - Felipe Yamaguchi
- College of Health Sciences, Kinesiology and Applied Physiology, University of Delaware, Newark, United States
| | - John J Jeka
- College of Health Sciences, Kinesiology and Applied Physiology, University of Delaware, Newark, United States
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Kaminski TW, Weinstein S, Wahlquist VE. A comprehensive prospective examination of purposeful heading in American interscholastic and collegiate soccer players. SCI MED FOOTBALL 2019. [DOI: 10.1080/24733938.2019.1696470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Thomas W. Kaminski
- Department of Kinesiology and Applied Physiology, Athletic Training Research Lab, University of Delaware, Newark, DE, USA
| | - Sarah Weinstein
- Family Medicine, Crozer Chester Medical Center, Springfield, PA, USA
| | - Victoria E. Wahlquist
- Department of Kinesiology and Applied Physiology, Athletic Training Research Lab, University of Delaware, Newark, DE, USA
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10
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Factors Associated with Sport-Related Post-concussion Headache and Opportunities for Treatment. Curr Pain Headache Rep 2018; 22:75. [DOI: 10.1007/s11916-018-0724-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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